When cancer and heart failure cross paths: a case report of severe cardiorenal compromise associated with the anti-CD20 monoclonal antibody rituximab in a patient with dilated cardiomyopathy.

Abstract

The authors describe the case of a 41-year-old man with end-stage, nonischemic dilated cardiomyopathy of 11 years' duration. The patient had been deemed ineligible for transplantation, despite his young age, when he was diagnosed with non-Hodgkin's lymphoma 7 years previously. Since he had survived the lymphoma without significant chemotherapy, while his cardiovascular and renal status continued to deteriorate, the issue was revisited. In an attempt to at least render him eligible for an assist device, a novel, promising, and reportedly nontoxic immunomodulation therapy for his lymphoma was employed. This consisted of infusion of the monoclonal antibody rituximab, specifically targeting the CD20 antigen on B cells. Despite testimonials concerning the benign nature of the treatment, the patient was unable to tolerate it and his clinical condition deteriorated rapidly, eventually leading to his death. The authors discuss potential mechanisms that might have accounted for the patient's cardiorenal compromise, with a focus on a very rare "cytokine release" syndrome attributed to this type of monoclonal antibody therapy and the probable interplay of cytokines in advanced heart failure. (c)2001 CHF, Inc.