Can lymphoma cause pleural effusion?

From the Guidelines

Yes, lymphoma can cause pleural effusion, with approximately 10% of malignant pleural effusions being due to lymphoma, as reported in the American Journal of Respiratory and Critical Care Medicine 1. Pleural effusion occurs when lymphoma cells infiltrate the pleural space or block lymphatic drainage, leading to fluid accumulation between the layers of the pleura surrounding the lungs. This is particularly common in non-Hodgkin lymphoma but can also occur in Hodgkin lymphoma. The effusion may be unilateral or bilateral and often contains malignant lymphoma cells. Some key points to consider include:

• The incidence of pleural effusion in lymphoma patients varies, with reports ranging from 5% to 33% in Hodgkin’s disease and 15% in non-Hodgkin’s lymphoma 1.
• Patients with lymphoma-related pleural effusion typically experience symptoms such as shortness of breath, chest pain, and cough.
• Diagnosis involves thoracentesis to sample the fluid for cytology and flow cytometry to identify malignant cells.
• Treatment primarily focuses on addressing the underlying lymphoma with appropriate chemotherapy regimens, which often leads to resolution of the effusion, as noted in the Annals of Oncology 1.
• In cases of large, symptomatic effusions, therapeutic thoracentesis or placement of a pleural catheter may be necessary for immediate symptom relief while awaiting response to systemic therapy.
• The presence of pleural effusion in lymphoma patients is generally associated with advanced disease and may impact prognosis, with an average survival time after the first thoracentesis of around 6 or 7 months 1.

From the Research

Lymphoma and Pleural Effusion

• Lymphoma can cause pleural effusion, as seen in a study of diffuse large B-cell lymphoma (DLBCL) patients, where 30% of patients had pleural effusions 2.
• The presence of pleural effusion in DLBCL patients is associated with a poor prognosis, with a hazard ratio of 1.9 for poor survival 2.
• Pleural effusions in lymphoma patients can be malignant, with cytological and/or flow cytometric analyses providing a diagnosis in about 70% of cases 2.

Clinical Features of Pleural Effusion in Lymphoma

• Pleural effusions in lymphoma patients can be exudates with adenosine deaminase levels > 35 U/L in 35% of cases 2.
• More than one-third of lymphomatous pleural effusions may require definitive pleural procedures for symptomatic relief 2.
• The size of the pleural effusion can be an independent predictor of poor survival, with effusions greater than 200 mL on CT scans being associated with a poor prognosis 2.

Treatment-Related Pulmonary Complications

• Lymphoma patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) may experience severe pulmonary adverse events, including pleural effusion 3.
• The use of steroids for conditions other than lymphoma can increase the risk of pulmonary infection, including Pneumocystis jiroveci pneumonia 3.
• Cardiovascular adverse events, including heart failure, can occur in lymphoma patients treated with R-CHOP or CHOP, with a pooled proportion of 4.62% for heart failure 4.