Management of primary central nervous system lymphoma and coexisting heart failure with reduced ejection fraction: a narrative review.

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardio-oncology Pub Date : 2025-08-27 DOI:10.1186/s40959-025-00374-x

Vanessa M Barrionuevo-Villacis, Mauricio X Davila

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Abstract

Background: Patients with primary central nervous system lymphoma (PCNSL) often require high-dose methotrexate (HD-MTX)-based regimens for effective disease control. However, the coexistence of heart failure with a reduced ejection fraction (HFrEF) poses significant challenges due to the increased risk of treatment-related cardiotoxicity and the potential exacerbation of cardiac dysfunction from fluid overload.

Main body: This review explores current PCNSL treatment modalities and their implications for patients with HFrEF. These findings emphasize the importance of multidisciplinary care, the cardiovascular risks associated with HD-MTX and adjunct therapies, and the strategies available to mitigate these risks.

Conclusion: Managing PCNSL in patients with HFrEF requires individualized therapy, vigilant monitoring, and strong collaboration between oncology and cardiology teams. Emerging therapies may reduce cardiotoxicity, but further evidence is needed to guide their safe use in this vulnerable population.

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原发性中枢神经系统淋巴瘤和并发心力衰竭伴射血分数降低的治疗：一篇叙述性综述。

背景：原发性中枢神经系统淋巴瘤（PCNSL）患者通常需要以高剂量甲氨蝶呤（HD-MTX）为基础的方案来有效控制疾病。然而，心力衰竭与射血分数降低（HFrEF）共存带来了重大挑战，因为与治疗相关的心脏毒性风险增加，以及液体过载可能加剧心功能障碍。本综述探讨了目前的PCNSL治疗方式及其对HFrEF患者的影响。这些发现强调了多学科护理的重要性，与HD-MTX和辅助治疗相关的心血管风险，以及减轻这些风险的策略。结论：治疗HFrEF患者的PCNSL需要个体化治疗、警惕监测以及肿瘤学和心脏病学团队的紧密合作。新兴疗法可能会减少心脏毒性，但需要进一步的证据来指导这些易感人群的安全使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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