Delayed anthracycline-induced cardiomyopathy – case report Case report
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Abstract
A 43-year-old man was admitted to the hematology department due to second recurrence of anaplastic lymphoma T-cell ALK+. Lymphoma was diagnosed 28 years earlier. The patient received COP regimen (17 cycles) and CHOP (5 cycles), radiotherapy and underwent splenectomy. He achieved complete remission at that time. Relapse of the disease was diagnosed 8 years later, which was treated with 6 cycles of chemotherapy (cytarabine, mitoxantrone, vepeside and glucocorticoids) and high-dose chemotherapy followed by hematopoietic stem cell transplantation. Second disease recurrence was found in 2013, it was anaplastic lymphoma T-cell ALK+ stage IIA by Ann Arbor. Echocardiography and myocardial perfusion scintigraphy revealed chronic heart failure NYHA class I. Angiotensin receptor antagonist (ramipril) and β-blocker (carvedilol) were recommended. The patient underwent 6 cycles of ESHAP, complete remission was reported after the second cycle. High-dose therapy with autologous stem cell rescue was considered at that time. However, having T-cell ALK+ lymphoma with a relatively good prognosis, previous prolonged complete remissions (respectively – 12 and 8 years), an insufficient yield from the harvest (3,33 × 106/kg CD34+ cells), heart failure and chronic active viral hepatitis B, the high risk intensive chemotherapy followed by hematopoietic stem cells transplantation was discontinued. The chemotherapy was complicated by brachial vein and superficial vein thrombosis of left upper limb and hypogammaglobulinemia. Follow-up echocardiography performed after completion of chemotherapy showed improvement in EF (64%).
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