Successful Treatment of Concomitant Pleural Mucosa-Associated Lymphoid Tissue Lymphoma and Monoclonal Gammopathy of Undetermined Significance with Lenalidomide, Rituximab, and Dexamethasone.

Concomitant plasma cell and B cell neoplasms in a single patient have been infrequently reported. It is known that the prognosis of these patients is worse than that of patients with single-disease onset. Generally, the chemotherapy specific for each disease is provided sequentially. It has been suggested that the specific chemotherapy for lymphoma could lead to the occurrence of refractory multiple myeloma (MM). We present a case with the concomitant occurrence of mucosa-associated lymphoid tissue (MALT) lymphoma and monoclonal gammopathy of undetermined significance (MGUS). MGUS does not usually require aggressive treatment. However, the potential adverse effects of MGUS on the treatment course of the B cell lymphoma were concerning. Therefore, we explored a new therapeutic approach that is simultaneously effective against both diseases. Combination therapy of lenalidomide (LEN) and rituximab (RIT) gained indication for follicular lymphoma and MALT lymphoma recently. LEN is also a key drug in MM treatment. Both diseases in our patient were effectively treated with the combination of LEN, RIT, and dexamethasone. With this combination therapy, we expect a prognostic improvement in concomitant MM and B cell lymphoma cases.

Fulminant lymphocytic myocarditis: Prediction of successful weaning from Impella support for cardiogenic shock.

We present a series of four patients with biopsy-proven fulminant lymphocytic myocarditis with cardiogenic shock and discuss whether it is possible to predict recovery of left ventricular function and successful weaning at the time of initial placement of mechanical circulatory support. Impella CP (Abiomed, Danvers, MA, USA) was placed in these patients on admission. Patients 1 and 2 made complete recovery. Patient 3 proceeded to bi-ventricular assist device and is currently waiting for transplantation. Patient 4 proceeded to Impella 5 but died from multiple organ failure. Although the Impella provides excellent hemodynamic support, outcomes of the patients with fulminant myocarditis with Impella support may depend upon the severity of myocarditis and myocardial failure. In addition to the previously reported predictors such as the level of elevated biomarkers, the severity of ventricular wall edema, and the development of rhythm disturbances, the absence of right ventricular dysfunction seems important to predict successful weaning from Impella support. .