Abstract 11622: A Case of Successful Malignant Lymphoma Treatment Following Transcatheter Aortic Valve Replacement

Abstract

Doxorubicin, an anthracycline drug, is a key drug in the treatment for diffuse large B-cell lymphoma (DLBCL). It is contraindicated in patients with serious heart diseases due to the cardiotoxicity. Transcatheter aortic valve replacement (TAVR) has been an established treatment for patients with severe aortic stenosis (AS) at high or prohibitive risk for surgical aortic valve replacement (SAVR). A 67-year-old woman was referred to our department with severe AS. Two months ago, the patient presented with bilateral cervical and inguinal lymphadenopathy. A biopsy of the lymph nodes revealed the primary diffuse large B-cell lymphoma (DLBCL). The patient had been diagnosed with stage IVA non-Hodgkin lymphoma according to the Ann Arbor staging system. The echocardiogram demonstrated a left ventricular ejection fraction of 67% and severe bicuspid AS with a peak velocity of 4.1 m/sec, mean pressure gradient of 44.1 mmHg, and aortic valve area of 0.58 cm 2 . She was initially treated with chemotherapy without anthracycline due to the high risk of anthracycline cardiotoxicity. However, anthracyclines were thought to be essential for controlling DLBCL. She was referred to our department and evaluated from the heart-team, which considered the following characteristics: severe impairment of mobility and frailty with a Society of Thoracic Surgeons (STS) score of 5.99%. Due to the high surgical risk for SAVR, we decided to perform TAVR. The procedure was completed without complications during the perioperative period. Ten days after TAVR, the patient received the therapy of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), which resulted in complete remission without cardiac symptoms. Before the advent of TAVR, it was difficult for patients with both severe AS and cancer to receive surgery and/or cardiotoxic treatment. In patients with cancer, AS may interfere with optimal antineoplastic therapy (ie, high-risk oncological surgery and/or cardiotoxic anticancer drugs). TAVR does not need cardiac arrest, extracorporeal circulation, and thoracotomy. TAVR could increase therapeutic options in cancer patients with severe AS who are at high surgical risk.