A narrative review of cardiac lymphoma in Africa: diagnostic challenges, treatment outcomes, and future perspectives

Abstract

Cardiac lymphomas, while rare, present distinct clinical and diagnostic challenges within the African healthcare context. This narrative review synthesizes current evidence on cardiac lymphomas in Africa, with emphasis on epidemiological patterns, clinical manifestations, diagnostic limitations, and treatment strategies. A comprehensive synthesis of the literature affirms that primary cardiac lymphomas remain exceedingly rare across the continent, while secondary cardiac involvement, particularly from high-grade non-Hodgkin lymphomas such as Burkitt lymphoma, appears more frequently. Clinical presentations are heterogeneous but commonly mimic heart failure, with dyspnea being the most prevalent symptom. Diagnostic challenges are pervasive due to limited access to advanced imaging modalities; echocardiography and chest radiography, though widely used, frequently yield non-specific findings. The high burden of human immunodeficiency virus (HIV) infection significantly influences the disease profile, driving the predominance of aggressive B-cell lymphomas. Therapeutic interventions, primarily based on CHOP (Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) or R-CHOP (with the addition of Rituximab) chemotherapy regimens, are generally adapted from international guidelines; however, their implementation is constrained by systemic limitations, including resource availability and healthcare infrastructure. Prognosis is influenced by the extent of myocardial involvement, comorbid conditions, and critical socioeconomic factors such as treatment affordability. Although infrequent, cardiac lymphomas constitute a critical clinical entity in Africa, necessitating increased awareness and targeted strategies. Strengthening diagnostic capacity, developing context-specific treatment algorithms, and fostering regional research collaborations are essential to improve outcomes and inform evidence-based management in resource-limited settings.