Case Report of Long-Term Complete Remission with Liposomal Doxorubicin for Treatment of Cardiac Involvement in Diffuse Large B-Cell Lymphoma.

Cardiac involvement in diffuse large B-cell lymphoma (DLBCL) is rare and poses diagnostic and therapeutic challenges. We report a 57-year-old male presenting with dysphagia, right-sided tonsillar enlargement, and nocturnal cough. Imaging showed bilateral cervical lymphadenopathy, a right tonsillar mass, and a cardiac mass on echocardiography. Biopsy confirmed DLBCL (Lugano IV, IPI 4). Positron emission tomography-computed tomography (PET-CT) showed hypermetabolic lesions in the heart, testes, and multiple lymph nodes. Immunochemotherapy with rituximab, cyclophosphamide, doxorubicin hydrochloride liposomes, vincristine, and prednisone (R-CDOP) was initiated, with dose adjustments for cardiac toxicity. After three cycles, partial remission was achieved. Subsequent cycles using the Rituximab, Vincristine, Cyclophosphamide, Prednisone (R-CVP) regimen led to a complete metabolic response on PET-CT. However, persistent atrial flutter required beta-blockade. The patient remains in remission at 24-month follow-up. This case highlights that DLBCL, with cardiac involvement responds to aggressive but tailored chemotherapy. Close monitoring and management of cardiac complications are critical for favorable outcomes. The individualized treatment approach, including dose modification and specific management of cardiac complications, played a key role in the patient's successful treatment.