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

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.