Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report
Background. Elaborated chemotherapy protocols used for a broad spectrum of solid and haematological malignancies have a significant cardiotoxicity potential. Different biologic mechanisms generated by Doxorubicin used in ABVD protocol, induce irreversible myocardial alterations, like type I cancer t...
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| Format: | Article |
| Language: | English |
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Amaltea Medical Publishing House
2020-09-01
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| Series: | Romanian Journal of Medical Practice |
| Subjects: | |
| Online Access: | https://rjmp.com.ro/articles/2020.3/RJMP_2020_3_Art-13.pdf |
| _version_ | 1818590420869840896 |
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| author | Maria Andrada JIGA Mariana Cornelia TILINCA Dragos Gabriel IANCU Paula Anca SULEA Marian POP |
| author_facet | Maria Andrada JIGA Mariana Cornelia TILINCA Dragos Gabriel IANCU Paula Anca SULEA Marian POP |
| author_sort | Maria Andrada JIGA |
| collection | DOAJ |
| description | Background. Elaborated chemotherapy protocols used for a broad spectrum of solid and haematological malignancies have a significant cardiotoxicity potential. Different biologic mechanisms generated by Doxorubicin used in ABVD protocol, induce irreversible myocardial alterations, like type I cancer therapeutics-related cardiac dysfunction. The present case-report highlights the importance of comprehensive diagnostic evaluation of a common mitral valve disease and emphasizes the importance of the accurate etiology in a case of late cardiomyopathy anthracycline + radiation related.
Case presentation. A 46-year-old Caucasian woman was admitted in sequence of 20 years prior anthracycline chemotherapy + radiotherapy protocols (five MOPP cycles, one cycle of ABVD, and three radiotherapy cycles of mantle Cobalt-60 therapy) for stage IIB Hodgkin lymphoma, medical investigations supporting a diagnosis of cardiotoxicity. The optimal pharmacological regimen for heart failure was prescribed with significant improvement of symptoms six months later. Consecutive four-year regular follow-up, complete clinical workup, lab tests and high-performance imaging studies endorsed a slow progression of cardiomyopathy with the appearance of a left bundle branch block and a balanced clinical status. Except cardiac and thyroid involvement, no relapse of Hodgkin lymphoma, musculoskeletal disease or other malignancies were identified 24 years after chemotherapy and radiation.
Pathogenesis of late-onset chronic development cardiotoxicity anthracycline-containing chemotherapy + mediastinal radiotherapy related remains unclear, resulting from multifactorial and complex mechanisms, and usually is considered irreversible. Notably, long-term survivors who experienced Hodgkin lymphoma in childhood or young age, appear to be susceptible and remain at increased risk of developing heart failure decades after.
Conclusions. From the setting-up of targeted therapy for Hodgkin lymphoma, cardio-oncology knowledge should be joined, avoiding the late stages, when symptomatic heart failure occurs. For Hodgkin lymphoma treated patients, serial follow-up and individualized approach are required to reduce the continuously increased risk of future CV events. |
| first_indexed | 2024-12-16T09:56:16Z |
| format | Article |
| id | doaj.art-a29d0526b20b4489b83f9a76f2cc6e83 |
| institution | Directory Open Access Journal |
| issn | 1842-8258 2069-6108 |
| language | English |
| last_indexed | 2024-12-16T09:56:16Z |
| publishDate | 2020-09-01 |
| publisher | Amaltea Medical Publishing House |
| record_format | Article |
| series | Romanian Journal of Medical Practice |
| spelling | doaj.art-a29d0526b20b4489b83f9a76f2cc6e832022-12-21T22:35:54ZengAmaltea Medical Publishing HouseRomanian Journal of Medical Practice1842-82582069-61082020-09-0115333333910.37897/RJMP.2020.3.13Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case reportMaria Andrada JIGA0Mariana Cornelia TILINCA1Dragos Gabriel IANCU2Paula Anca SULEA3Marian POP4 Internal Medicine – Cardiology II Unit, Emergency County Hospital Targu Mures, Romania Department ME2, Faculty of Medicine in English, “G.E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania Internal Medicine – Cardiology II Unit, Emergency County Hospital Targu Mures, RomaniaEmergency County Hospital Targu Mures, Romania Department ME2, Faculty of Medicine in English, “G.E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania; Radiology and Medical Imaging Clinic, Emergency County Hospital Targu Mures, RomaniaBackground. Elaborated chemotherapy protocols used for a broad spectrum of solid and haematological malignancies have a significant cardiotoxicity potential. Different biologic mechanisms generated by Doxorubicin used in ABVD protocol, induce irreversible myocardial alterations, like type I cancer therapeutics-related cardiac dysfunction. The present case-report highlights the importance of comprehensive diagnostic evaluation of a common mitral valve disease and emphasizes the importance of the accurate etiology in a case of late cardiomyopathy anthracycline + radiation related. Case presentation. A 46-year-old Caucasian woman was admitted in sequence of 20 years prior anthracycline chemotherapy + radiotherapy protocols (five MOPP cycles, one cycle of ABVD, and three radiotherapy cycles of mantle Cobalt-60 therapy) for stage IIB Hodgkin lymphoma, medical investigations supporting a diagnosis of cardiotoxicity. The optimal pharmacological regimen for heart failure was prescribed with significant improvement of symptoms six months later. Consecutive four-year regular follow-up, complete clinical workup, lab tests and high-performance imaging studies endorsed a slow progression of cardiomyopathy with the appearance of a left bundle branch block and a balanced clinical status. Except cardiac and thyroid involvement, no relapse of Hodgkin lymphoma, musculoskeletal disease or other malignancies were identified 24 years after chemotherapy and radiation. Pathogenesis of late-onset chronic development cardiotoxicity anthracycline-containing chemotherapy + mediastinal radiotherapy related remains unclear, resulting from multifactorial and complex mechanisms, and usually is considered irreversible. Notably, long-term survivors who experienced Hodgkin lymphoma in childhood or young age, appear to be susceptible and remain at increased risk of developing heart failure decades after. Conclusions. From the setting-up of targeted therapy for Hodgkin lymphoma, cardio-oncology knowledge should be joined, avoiding the late stages, when symptomatic heart failure occurs. For Hodgkin lymphoma treated patients, serial follow-up and individualized approach are required to reduce the continuously increased risk of future CV events.https://rjmp.com.ro/articles/2020.3/RJMP_2020_3_Art-13.pdfadult hodgkin lymphoma survivorlate cardiotoxicityheart failuremitral regurgitationcardiac conduction disordertreatmentlong term follow-upcase report |
| spellingShingle | Maria Andrada JIGA Mariana Cornelia TILINCA Dragos Gabriel IANCU Paula Anca SULEA Marian POP Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report Romanian Journal of Medical Practice adult hodgkin lymphoma survivor late cardiotoxicity heart failure mitral regurgitation cardiac conduction disorder treatment long term follow-up case report |
| title | Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report |
| title_full | Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report |
| title_fullStr | Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report |
| title_full_unstemmed | Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report |
| title_short | Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report |
| title_sort | progressive late cardiac dysfunctions chemo and radiotherapy related in a middle age woman with hodgkin lymphoma a case report |
| topic | adult hodgkin lymphoma survivor late cardiotoxicity heart failure mitral regurgitation cardiac conduction disorder treatment long term follow-up case report |
| url | https://rjmp.com.ro/articles/2020.3/RJMP_2020_3_Art-13.pdf |
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