ORCID

0009-0003-3263-2897 (Priessnitz)

Document Type

Abstract

Publication Date

2025

Publication Title

Journal of the American College of Cardiology

Volume

85

Issue

12 Suppl. A

Pages

3907

Abstract

Background: Cardiac sequelae in Hodgkin Lymphoma (HL) can manifest as involvement of the heart and pericardium. Direct cardiac involvement is rare, and myocardial infiltration is distinctly unusual.¹ When it does occur, it is often a late manifestation of lymphoma, with a median onset of 20 months after initial diagnosis, and it is usually associated with advanced-stage disease.²

Case: A 34-year-old male was diagnosed with classic HL by lymph node biopsy. During his hospitalization, the patient remained in sinus tachycardia with heart rate up to 150 with no dysrhythmias. Transthoracic echocardiogram (TTE) revealed a reduced ejection fraction (EF) of 36% concerning for nonischemic cardiomyopathy, thus the patient was started on guideline-directed medical therapy. Cardiac magnetic resonance imaging (MRI) was remarkable for global left ventricular hypokinesis and a nonischemic linear mid-myocardial scar in the basal through mid-interventricular septum, raising concerns for HL myocardial infiltration. Given the known cardiotoxicity of doxorubicin, this therapeutic was omitted from the initial chemotherapy regimen for the HL; cycle 1 and 2 consisted of only brentuximab, vinblastine, and dacarbazine with plan to repeat TTE after each cycle.

Decision-making: In patients with HL, doxorubicin-induced cardiomyopathy is rarely seen in patients who receive a total dose less than 400 mg/m²,³. Patients who are treated with 6 cycles of doxorubicin, brentuximab, vinblastine and dacarbazine receive a total doxorubicin dose of 300 mg/m²; however, long-term cardiac toxicity, arrhythmias, an heart failure remain risks.³ Despite the cardiotoxicity of doxorubicin, it is still described as the only effective therapy for cardiac infiltrative lymphomas.⁴,⁵

Conclusion: This patient and his care team later agreed to aggressively treat the HL by including doxorubicin in cycle 3 of chemotherapy. Upon repeat TTE, EF improved to 47%, supporting the suspicion that myocardial infiltration of the HL was contributory to the cardiomyopathy and that treatment with doxorubicin would ultimately improve his heart function.

Rights

Copyright © 2025, American College of Cardiology Foundation.

This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC-BY-NC-ND 4.0) License.

Comments

Bibliographic note: While published under a Creative Commons License, this abstract is not freely accessible on the publisher's website.

Original Publication Citation

Priessnitz, J., Biringen, E., Khoury, F., & Bergin, C. (2025). Treatment of myocardial infiltration of Hodgkin's Lymphoma: A catch-22. Journal of the American College of Cardiology, 85(12 Suppl. 1) 3907. https://www.jacc.org/doi/10.1016/S0735-1097%2825%2904391-8

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