At diagnosis, the patient’s AFP (alpha-fetoprotein) level was slightly elevated. Unfortunately, this patient was not deemed a surgical candidate. She began treatment with Y90 radioembolization and systemic immunotherapy with atezolizumab and bevacizumab but disease progressed despite change in treatment options and eventually decision was made by patient and family to transition to comfort care.
pre-existing liver disease. Unlike conventional HCC, FLC is characterized by distinct histopathological features and the DNAJB1-PRKACA gene fusion, a reliable diagnostic marker. Most patients present with vague abdominal symptoms, leading to delayed diagnosis. Surgical resection remains the primary curative option, but recurrence is common, and metastatic disease often complicates treatment. This case underscores the challenges of managing FLC and highlights the need for continued research into more effective and targeted therapies.
Discussion: FLC is a rare subtype of HCC typically affecting adolescents and young adults without
TREATMENT TO TURMOIL: IBRUTINIB’S IMPACT ON CARDIOVASCULAR OUTCOMES IN LYMPHOPLASMACYTIC LYMPHOMA Kathryn Ruckstuhl, Anaiya Singh, Poornima Ramadas; Louisiana State University School of Medicine, Shreveport, LA.
Introduction: This case explores the onset of cardiac complications, including heart failure and atrial fibrillation, in a patient undergoing treatment for lymphoplasmacytic lymphoma with Ibrutinib. It highlights the importance of cardiac monitoring in patients receiving novel therapies. Case: A 62-year-old man with hypertension was found to have monoclonal gammopathy during routine laboratory tests. Subsequently a bone marrow biopsy was performed indicating the presence of B-cell lymphoma with plasmacytic differentiation. Immunophenotyping revealed that the cells were negative for CD5 and CD10. However, the presence of MYD88 positivity was identified, which led to a diagnosis of lymphoplasmacytic lymphoma. The patient exhibited no significant systemic symptoms or bone lesions, while a PET scan indicated pulmonary lesions, ultimately diagnosed as granulomatous inflammation. Treatment began with Bendamustine and Rituximab but was halted due to severe neutropenia, leading to a transition to Ibrutinib with partial response appreciated a few months later. Ten months after initiation the patient presented with exertional and rest dyspnea, palpitations, and dizziness, revealing a rapid heart rate indicative of
atrial fibrillation with rapid ventricular response. Initial echocardiography showed a reduced ejection fraction (EF) of 40%, compared to a baseline EF of 55-60%. Given the findings of new-onset heart failure with reduced ejection fraction (HFrEF) and pericardial effusion, a multidisciplinary decision was made to discontinue Ibrutinib. Subsequently, the patient was treated with rituximab and cyclophosphamide for his lymphoplasmacytic lymphoma, alongside optimized guideline-directed medical therapy for heart failure. Over a six-month follow-up period, the patient demonstrated a remarkable recovery in cardiac function, with echocardiographic evaluation revealing a return to a normal EF of 55%. Discussion: There are several unique aspects within this case including the delayed onset of heart failure and the development of new onset atrial fibrillation nearly a year after initiating ibrutinib. This patient experienced rapid resolution of cardiac function, with ejection fraction returning to baseline within six months of discontinuing the drug. This case highlights the importance of ongoing cardiac monitoring in patients that receive ibrutinib and emphasizes the role of interdisciplinary management between oncology and cardiology.
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