Progressive late cardiac dysfunctions chemo- and radiotherapy related in a middle age woman with Hodgkin lymphoma – a case report

Abstract

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.

Keywords

• adult hodgkin lymphoma survivor
• late cardiotoxicity
• heart failure
• mitral regurgitation
• cardiac conduction disorder
• treatment
• long term follow-up
• case report