Cardiac lymphoma requiring urgent heart transplant due to ventricular tachycardia storm: a case report
Bibliographic record
Abstract
Abstract Background Primary cardiac lymphoma (PCL) involves the heart almost exclusively although it can extend to surrounding structures including the pericardium. Most PCLs in adults are of B-cell origin and their signs and symptoms are generally non-specific and depend on their location and size. In general, cancer patients usually have a slim chance of receiving heart transplantation (OHT), although it’s not an absolute contraindication depending on the decision of the multidisciplinary team and the experience of each institution. Case Summary A 48-year-old man, with an ultimate diagnosis of primary cardiac follicular B-cell lymphoma presented to our hospital mimicking hypertrophic cardiomyopathy. He initially presented with worsening heart failure and ventricular tachycardia storm (VT-S) that required urgent cardiac OHT. The final pathological analysis of the explanted heart revealed the presence of a PCL without extra-cardiac extension. In addition to initial immunosuppression with mycophenolate mophethyl, corticosteroids, and tacrolimus, he was switched to Everolimus and dose reduction of Tacrolimus. Rituximab + Bendamustine was initiated to reduce the risk of cardiotoxicity and myelotoxicity associated to R-CHOP. The follow-up body PET-CT, trans-thoracic echocardiogram, cardiac magnetic resonance imagings and biopsies were normal. During a regular follow-up heart biopsy procedure to ascertain rejection, the patient developed torrential tricuspid regurgitation and required surgical valve replacement. Discussion After 5.5 years of follow-up, the patient remains asymptomatic, with normal graft function, in NYHA FC I, and without oncological relapses despite receiving a modified chemotherapy regimen. Selected patients with a PCL can be managed with OHT and a modified chemotherapy regimen. They could also be followed up using a non-invasive approach to monitor rejection.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".