Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. May 24, 2025; 16(5): 104471
Published online May 24, 2025. doi: 10.5306/wjco.v16.i5.104471
Rituximab-based regimens for primary cardiac lymphoma: A systematic review of outcomes, challenges and future directions
Syed Faqeer Hussain Bokhari, Danyal Bakht, Abdul Haseeb Hasan, Muhammad Ali Abid, Maaz Amir, Khawar Ali, Muhammad Arsham Javed, Faria Khilji, Asma Iqbal, Wahidullah Dost
Syed Faqeer Hussain Bokhari, Danyal Bakht, Abdul Haseeb Hasan, Muhammad Ali Abid, Maaz Amir, Khawar Ali, Muhammad Arsham Javed, Asma Iqbal, Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Faria Khilji, Department of Medicine and Surgery, Quaid-e-Azam Medical College, Bahawalpur, Bahawalpur 54000, Punjab, Pakistan
Wahidullah Dost, Department of Curative Medicine, Kabul University of Medical Sciences, Kabul 10001, Kābul, Afghanistan
Author contributions: Bokhari SFH, Bakht D, and Hasan AH were responsible for the conceptualization and design of the study; Abid MA, Amir M, and Ali K conducted the literature search and data extraction; data analysis and interpretation were performed by Bakht D, Javed MA, and Khilji F; the initial manuscript draft was prepared by Javed MA, Khilji F, and Iqbal A, while Hasan AH, Iqbal A, and Dost W critically reviewed and revised the manuscript for intellectual content; Dost W provided overall supervision and gave the final approval for submission; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest relevant to this study. No financial, personal, or professional relationships influenced the conduct of this research, the interpretation of data, or the preparation of this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wahidullah Dost, Department of Curative medicine, Kabul University of Medical Sciences, Karte-e-sakhi Kabul, Kabul 10001, Kābul, Afghanistan. wahidullahdost96@gmail.com
Received: December 23, 2024
Revised: February 12, 2025
Accepted: March 6, 2025
Published online: May 24, 2025
Processing time: 149 Days and 16.1 Hours
Abstract
BACKGROUND

Primary cardiac lymphoma (PCL) is a rare subset of cardiac tumors, often diagnosed late due to nonspecific symptoms. It predominantly affects immunocompromised individuals, primarily in the pericardium and right heart. Late diagnosis mimics common cardiac ailments, leading to poor prognosis.

AIM

To systematically review the efficacy of rituximab in treating PCL either alone or in various chemotherapeutic regimens. Secondary objectives include evaluating morphological subtypes, assessing treatment regimens, and analyzing outcomes focusing on remission and adverse events.

METHODS

Following PRISMA guidelines, a comprehensive literature search was conducted across multiple databases, including PubMed, Hinari, Web of Science, and Scopus. English-language studies reporting the use of rituximab in treating PCL in humans were included. Study selection involved initial screening of titles and abstracts followed by full-text examination and data extraction.

RESULTS

Thirty-three case reports involving 36 patients were included in this systematic review. Diffuse large B-cell lymphoma was the predominant morphological subtype observed. The rituximab, cyclophosphamide, doxorubicin, oncovin, and prednisolone regimen emerged as the most commonly employed treatment strategy, indicating widespread acceptance and efficacy in PCL management. Combination therapies, including surgical intervention, showed promise in achieving complete remission, while some studies reported mortality despite aggressive treatment approaches.

CONCLUSION

Rituximab, particularly in combination with chemotherapy regimens, represents a significant advancement in PCL management, offering hope for improved patient outcomes. However, challenges such as variable treatment responses and adverse events underscore the complexity of managing PCL. Further research is warranted to refine therapeutic strategies and enhance diagnostic approaches for this rare cardiac malignancy.

Keywords: Primary cardiac lymphoma; Oncology; Review; Rituximab; B cell lymphoma

Core Tip: This systematic review highlights the efficacy of rituximab-based regimens, particularly rituximab, cyclophosphamide, doxorubicin, oncovin, and prednisolone, in managing primary cardiac lymphoma, a rare and aggressive malignancy. Diffuse large B-cell lymphoma is the most common subtype, and combination therapies, including surgical intervention, show promise in achieving complete remission. However, variability in treatment responses and the risk of adverse events remain significant challenges. Enhanced diagnostic methods and further research are essential to optimize therapeutic strategies and improve outcomes for patients with this rare cardiac tumor.