ABSTRACT
R-CVP (cyclophosphamide, vincristine, prednisone) and R-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone + rituximab) are immunochemotherapy regimens frequently used for remission induction of indolent non-Hodgkin lymphomas (iNHLs). Rituximab maintenance (RM) significantly improves progression-free survival (PFS) in patients with complete/partial remission (CR/PR). Here we report the final results of a randomized study comparing R-CVP to R-CHOP both followed by RM. Untreated patients in need of systemic therapy with symptomatic and progressive iNHLs including follicular (FL) and marginal zone lymphoma (MZL), mucosa-associated lymphoid tissue (MALT), small lymphocytic (SLL), and lymphoplasmacytic (LPL) lymphoma were eligible. Patients were randomized to receive R-CVP or R-CHOP for eight cycles or until complete response (CR). All patients with CR/PR (partial response) received RM 375 mg/m2 q 2 months for 12 cycles. Primary endpoint was event-free survival (EFS). Two-hundred and fifty patients [FL 42%, MZL/MALT 38%, LPL/ Waldenström Macroglobulinaemia (WM) 11%, SLL 9%] were enrolled and randomized (R-CHOP: 127, R-CVP: 123). Median age was 56 years (21-85), 44% were male, 90% were in stage III-IV, 43% of FL patients had a Follicular Lymphoma International Prognostic Index (FLIPI) score ≥3, and 33·4% of all patients had an IPI score ≥3. At the end of induction treatment, the CR/PR rate was 43·6/50·9% and 36·3/60·8% in the R-CHOP and R-CVP groups (P = 0·218) respectively. After a median follow-up of 67, 66, and 70 months, five-year EFS was 61% vs. 56% (not significant), progression-free survival (PFS) was 71% vs. 69% (not significant) and overall survival (OS) was 84% vs. 89% in the R-CHOP vs. the R-CVP arm respectively. Grade III/IV adverse events (65 vs. 22) occurred in 40 (33·1%) and 18 (15·3%) patients, P = 0·001; neutropenia in 16 (11·6%) and 4 (3·4%) patients, P = 0·017; infection in 14 (10·7%) and 3 (2·5%) patients,; P = 0·011; and a second neoplasm in three versus seven patients., in the R-CHOP and the R-CVP groups respectively. This multicentre randomized study with >five-year follow-up shows similar outcome in patients with indolent lymphoma in need of systemic therapy treated with R-CVP or R-CHOP immunochemotherapy and rituximab maintenance in both arms. The minor toxicity of the R-CVP regimen makes it a reasonable choice for induction treatment, leaving other active agents like doxorubicin or bendamustin for second-line therapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/therapeutic use , Immunotherapy/methods , Lymphoma, Follicular/drug therapy , Prednisone/therapeutic use , Rituximab/therapeutic use , Vincristine/therapeutic use , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Cyclophosphamide/pharmacology , Doxorubicin/pharmacology , Doxorubicin/therapeutic use , Female , Humans , Male , Middle Aged , Poland , Prednisone/pharmacology , Rituximab/pharmacology , Vincristine/pharmacologyABSTRACT
We presented a case of symptomatic secondary cardiac B-cell lymphoma localised in the free wall of the right ventricle (RV). It was detected during transthoracic echocardiography and confirmed by nuclear magnetic resonance imaging. The RV free wall motion abnormalities, decreased dimensions of RV and small pericardial effusion were found. The tumour dimensions declined after the first cycle of chemiotherapy with antracyclins.
Subject(s)
Heart Neoplasms/diagnostic imaging , Lymphoma, B-Cell/diagnostic imaging , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Echocardiography , Fatal Outcome , Female , Heart Neoplasms/complications , Heart Neoplasms/drug therapy , Heart Ventricles , Humans , Lymphoma, B-Cell/complications , Lymphoma, B-Cell/drug therapy , Middle Aged , Pericardial Effusion/etiology , Prednisolone/therapeutic use , Vincristine/therapeutic useABSTRACT
We presented a case of asymptomatic myxoma of the tricuspid valve septal leaflet. The tumour was diagnosed accidentally during rutine transthoracic echocardiography and confirmed by transesophageal echocardiography. It was resected and the septal leaflet repaired during surgery.
Subject(s)
Heart Neoplasms/diagnostic imaging , Myxoma/diagnostic imaging , Myxoma/surgery , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/surgery , Aged , Echocardiography , Echocardiography, Transesophageal , Female , Heart Neoplasms/surgery , Humans , Incidental FindingsABSTRACT
We presented a case of the large asymptomatic pericardial cyst localised near cardiac apex, filled with fluid of water- -equivalent density. The cyst was detected accidentally during transthoracic echocardiography and confirmed by 64-slice multi-detector computed tomography. Repeated transthoracic echocardiography was recommened.
Subject(s)
Mediastinal Cyst/diagnostic imaging , Echocardiography , Female , Humans , Middle Aged , Tomography, X-Ray ComputedABSTRACT
We present a rare case of fungal (Candida albicans) endocarditis on the two (mitral and aortic) biological prosthetic valves. Vegetations were detected by transthoracic echocardiography and confirmed by transesophageal echocardiography.
Subject(s)
Antifungal Agents/therapeutic use , Endocarditis/microbiology , Heart Valve Prosthesis/microbiology , Mycoses/drug therapy , Echocardiography/methods , Endocarditis/diagnostic imaging , Endocarditis/drug therapy , Female , Humans , Middle Aged , Mycoses/diagnostic imaging , Treatment OutcomeABSTRACT
We present a case of severe symptomatic tricuspid valve regurgitation due to shifting of the septal leaflet of the valve toward the interventricular septum by a permanent ventricular pacemaker lead, making coaptation of the tricuspid leflats in systole impossible.
Subject(s)
Electrodes, Implanted/adverse effects , Pacemaker, Artificial/adverse effects , Tricuspid Valve Insufficiency/etiology , Aged , Echocardiography, Doppler, Color/methods , Echocardiography, Three-Dimensional/methods , Female , HumansABSTRACT
We reported a case of a 45 year-old woman who had a quadricuspid aortic valve associated with moderate aortic regurgitation. The valve abnormality was detected by transthoracic echocardiography. Transesophageal echocardiography showed mild thickening of 4 symmetric aortic valve cusps, a small rectangular central regurgitant orifice, and moderate aortic insufficiency. In addition visualised this anomaly in 3D transesophageal echocardiography too.
Subject(s)
Aortic Valve Insufficiency/etiology , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Echocardiography, Doppler, Color/methods , Echocardiography, Three-Dimensional/methods , Female , Humans , Middle AgedABSTRACT
Ebstein anomaly is a congenital malformation of the heart that is characterised by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialisation of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet. We present a case of a mild type Ebstein anomaly leading to moderate tricuspid valve regurgitation and some degree of right ventricular dysfunction.
Subject(s)
Ebstein Anomaly/complications , Tricuspid Valve Insufficiency/etiology , Ventricular Dysfunction, Right/etiology , Ebstein Anomaly/diagnostic imaging , Echocardiography, Doppler, Color/methods , Heart Atria/abnormalities , Heart Ventricles/abnormalities , Humans , Male , Middle Aged , Severity of Illness Index , Tricuspid Valve/abnormalities , Tricuspid Valve Insufficiency/diagnostic imaging , Ventricular Dysfunction, Right/diagnostic imagingABSTRACT
We presented a very rare case of the fistula to coronary artery during staphylococcal aortic valve endocarditis in a young man. The tranesophageal echocardiography detected vegetation on aortic valve leaflets and large regurgitatin. During transesophageal echocardiography the peri-anular multi-chamber abscess formation and fistulous communication to circumflex coronary artery was detected.
Subject(s)
Aortic Valve , Coronary Artery Disease/etiology , Endocarditis, Bacterial/complications , Heart Valve Diseases/complications , Staphylococcal Infections/complications , Vascular Fistula/etiology , Adult , Aortic Valve/pathology , Coronary Artery Disease/diagnostic imaging , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnostic imaging , Heart Valve Diseases/diagnosis , Heart Ventricles/pathology , Humans , Male , Staphylococcal Infections/diagnostic imaging , Vascular Fistula/diagnostic imagingABSTRACT
We report a case of a 33-year-old man with infective endocarditis of both atrioventricular valves coexisting with a congenital heart defect: atrioventricular canal defect. Transthoracic and transesopageal echocardiography showed complete atrioventricular canal defect and vegetations affecting both the normal mitral and tricuspid valves. The patient received a combined antibiotic therapy and was qualified for cardiosurgical correction.
Subject(s)
Endocardial Cushion Defects/diagnosis , Endocarditis/diagnosis , Adult , Echocardiography , Electrocardiography , Endocardial Cushion Defects/complications , Endocarditis/etiology , Humans , Male , Mitral Valve/diagnostic imaging , Tricuspid Valve/diagnostic imagingABSTRACT
Systemic lupus erythromatosus is often associated with an antiphospholipid syndrome (APS). A high prevalence of valvular heart disease in APS leads to increased risk of embolic events, particularly cerebrovascular. We present a patient with cerebral infarction, with positive lupus anticoagulant, anticardiolipin antibodies and factor V Leiden mutation. Echocardiographic examination revealed mitral valve anterior leaflet thickening and verrucous vegetations consistent with Libman-Sacks endocarditis, which is commonly associated with APS.
Subject(s)
Antiphospholipid Syndrome/complications , Endocarditis/complications , Intracranial Embolism/etiology , Lupus Erythematosus, Systemic/complications , Adult , Antiphospholipid Syndrome/diagnosis , Cerebral Infarction/etiology , Echocardiography, Doppler , Endocarditis/diagnosis , Female , Humans , Lupus Erythematosus, Systemic/diagnosis , RecurrenceABSTRACT
We describe a patient with a severe, neoplastic pulmonary embolism due to primary cancer of the pancreas. The 40-year-old male was admitted to the haematology department with an initial diagnosis of lymphoma. Transthoracic echocardiography showed a mass in the right atrium. Transoesophageal echocardiography was performed and revealed two moving tumours: the first in the extend of the vena cava superior and the second one in the tricuspid valve annulus. After bronchoscopy the patient's haemodynamic condition deteriorated and was followed by cardiac arrest. Post-mortem examination showed extensive tumour emboli in the left pulmonary artery as well as pancreatic cancer at an advanced stage.
Subject(s)
Adenocarcinoma/complications , Heart Neoplasms/secondary , Neoplastic Cells, Circulating , Pancreatic Neoplasms/complications , Pulmonary Embolism/etiology , Vascular Neoplasms/secondary , Adenocarcinoma/secondary , Adult , Echocardiography, Transesophageal , Fatal Outcome , Heart Atria/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Humans , Male , Pancreatic Neoplasms/pathology , Pulmonary Embolism/pathology , Vascular Neoplasms/diagnostic imaging , Vena Cava, InferiorABSTRACT
We report a patient with a large, asymptomatic left atrial myxoma detected by transoesophageal echocardiography. The tumour filled the great part of the left atrium cave and led to mitral valve obstruction. Surgical management gave an excellent result.