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Knauft J, Schenk T, Ernst T, Schnetzke U, Hochhaus A, La Rosée P, Birndt S. Lymphoma-associated hemophagocytic lymphohistiocytosis (LA-HLH): a scoping review unveils clinical and diagnostic patterns of a lymphoma subgroup with poor prognosis. Leukemia 2024; 38:235-249. [PMID: 38238443 PMCID: PMC10844097 DOI: 10.1038/s41375-024-02135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome driven by pathologic activation of cytotoxic T-lymphocytes and macrophages. Despite advances in diagnostics and management, adult patients with lymphoma-associated HLH (LA-HLH) harbor particularly poor prognosis and optimal treatment remains challenging. As systematic data on LA-HLH are scarce, we aimed to synthesize research evidence by thorough analysis of the published literature in PubMed (MEDLINE-database) within the context of a scoping review. Of 595 search results, 132 articles providing information on 542 patients were reviewed and analyzed. Median patient age was 60 years (range, 18-98) with male predominance (62.7%). B- and T-NHL were equally represented (45.6% and 45.2%), Hodgkin's lymphoma was reported in 8.9% of the cases. The majority of patients (91.6%) presented in Ann-Arbor-Stages III and IV, and bone marrow infiltration was observed in a significant proportion of patients (61.5%). Soluble CD25 levels were markedly elevated (median 10,000 U/ml), with levels beyond 10,000 U/ml indicating unfavorable prognosis for 30-day and overall survival. 66.8% of the patients died after median 5.1 months. LA-HLH remains a clinical challenge requiring specialized management. Timely diagnosis and appropriate lymphoma-specific treatment are of utmost importance to enhance patient outcomes.
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Affiliation(s)
- Johanna Knauft
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Schenk
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Ernst
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Ulf Schnetzke
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Paul La Rosée
- Klinik für Innere Medizin II, Onkologie, Hämatologie, Immunologie, Infektiologie und Palliativmedizin, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Sebastian Birndt
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.
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Ojo A, Asemota J, Ojukwu S, Rajeh H, Bot A, Smith C, Laziuk K, Saleh M. B‑cell lymphoma‑associated hemophagocytic lymphohistiocytosis: A case report. Oncol Lett 2022; 24:246. [PMID: 35761945 PMCID: PMC9214690 DOI: 10.3892/ol.2022.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition characterized by an exaggerated but dysregulated immune response resulting in hyperinflammation, with a potential for progression to multiple organ dysfunction and failure. Infectious diseases, inflammatory disorders, malignancies and immunodeficiency syndromes are known triggers of HLH in adults. The present study reported the case of a middle-aged man with HLH triggered by B-cell lymphoma who was successfully treated with dexamethasone; etoposide, prednisone, vincristine, cyclophosphamide, hydroxy-doxorubicin and rituximab chemotherapy; and multiple intrathecal methotrexate with a good outcome.
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Affiliation(s)
- Ademola Ojo
- Department of Internal Medicine, Howard University Hospital, Washington, DC 20060, USA
| | - Joseph Asemota
- Department of Internal Medicine, Howard University Hospital, Washington, DC 20060, USA
| | - Somtochukwu Ojukwu
- Department of Internal Medicine, Howard University Hospital, Washington, DC 20060, USA
| | - Hmad Rajeh
- Department of Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Amina Bot
- Department of Internal Medicine, Howard University Hospital, Washington, DC 20060, USA
| | - Caitlyn Smith
- Department of Pathology and Anatomical Sciences, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Katsiaryna Laziuk
- Department of Pathology and Anatomical Sciences, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Mohammed Saleh
- Department of Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA
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Karakatsanis S, Panitsas F, Arapaki M, Galopoulos D, Asimakopoulos JV, Liaskas A, Chatzidimitriou C, Belia M, Konstantinou E, Vassilopoulos I, Papadatos SS, Sachanas S, Efstathopoulou M, Yiakoumis X, Pardalis V, Iliakis T, Giannakopoulou N, Dimou M, Chatzidavid S, Boutsikas G, Petevi K, Kanellopoulos A, Gainaru G, Variamis E, Siakantaris MP, Kyrtsonis MC, Plata E, Tsaftaridis P, Dimopoulou MN, Viniou NA, Syrigos KN, Pangalis GA, Panayiotidis P, Konstantopoulos K, Angelopoulou MK, Vassilakopoulos TP. Serum ferritin levels in previously untreated classical Hodgkin lymphoma: correlations and prognostic significance. Leuk Lymphoma 2022; 63:799-812. [DOI: 10.1080/10428194.2021.2010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Stamatios Karakatsanis
- Third Department of Internal Medicine and Laboratory, National and Kapoditrian University of Athens, School of Medicine, “Sotiria” General Hospital, Athens, Greece
| | - Fotios Panitsas
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Galopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athanassios Liaskas
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Marina Belia
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Elianna Konstantinou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Vassilopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Stamatis S. Papadatos
- Third Department of Internal Medicine and Laboratory, National and Kapoditrian University of Athens, School of Medicine, “Sotiria” General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Maria Efstathopoulou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Xanthoula Yiakoumis
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Vassilios Pardalis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Theodoros Iliakis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Nefeli Giannakopoulou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Sevastianos Chatzidavid
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Boutsikas
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Kyriaki Petevi
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandros Kanellopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Gabriella Gainaru
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina P. Siakantaris
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Eleni Plata
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panayiotis Tsaftaridis
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria N. Dimopoulou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos N. Syrigos
- Third Department of Internal Medicine and Laboratory, National and Kapoditrian University of Athens, School of Medicine, “Sotiria” General Hospital, Athens, Greece
| | | | - Panayiotis Panayiotidis
- First Department of Internal Medicine, Propaedeutic, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Meng GQ, Wang JS, Wang YN, Wei N, Wang Z. Rituximab-containing immuno-chemotherapy regimens are effective for the elimination of EBV for EBV-HLH with only and mainly B lymphocytes of EBV infection. Int Immunopharmacol 2021; 96:107606. [PMID: 33826999 DOI: 10.1016/j.intimp.2021.107606] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/27/2022]
Abstract
Patients with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) have a poor prognosis. This study investigated the efficacy of rituximab-containing immuno-chemotherapy regimens for EBV-HLH. In this study, 15 patients were treated with rituximab-containing regimens. The treatment efficacy and adverse events were evaluated. In 10 patients, EBV DNA became negative after the first course of treatment. The lymphocyte types infected by EBV in the 10 patients were only infected with B cells and mainly infected with B cells. In the other 5 patients, the EBV DNA of peripheral blood mononuclear cells (PBMC) before and after treatment with the regimens had no statistical difference (P = 0.111). In addition, in these 5 patients, EBV mainly infected T and NK cells. Among the 5 patients without a significant decline in EBV DNA of PBMC, 2 patients received allogeneic hematopoietic stem cell transplantation and turned negative for EBV DNA. This study suggests that rituximab-containing regimens are effective therapy for EBV-HLH with only and mainly B lymphocytes infected by EBV, especially for eliminating EBV.
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Affiliation(s)
- Guang-Qiang Meng
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Jing-Shi Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Yi-Ni Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Na Wei
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Zhao Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Paul N, Avalos C, Estifan E, Swyden S. Interstitial lung disease in dermatomyositis complicated by right ventricular thrombus secondary to macrophage activation syndrome- a case report. AME Case Rep 2020; 4:18. [PMID: 32793860 DOI: 10.21037/acr.2020.03.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Abstract
The course of dermatomyositis (DM) can be complicated by multi-organ failure, by complex pathophysiological mechanisms involving autoantibodies. Pulmonary complications are the leading cause of mortality, accounting for 30% of deaths. There is a strong association between DM and interstitial lung disease (ILD); clinically amyopathic dermatomyositis (CADM) has a stronger association with ILD as compared to a classic form of DM. ILD can be in the form of fibrosing alveolitis, interstitial pneumonia, and desquamative interstitial pneumonia or diffuse alveolar hemorrhage. Autoantibodies linked to ILD are anti Jo-1, PL12, PL7, EJ, and OJ and anti Mi 2. Our case describes a fifty-three years old woman who presented with symptoms of lower respiratory tract infection, diagnosed with CADM based on typical skin rash and polyarthritis and anti-CADM 140 antibodies. Systemic steroid therapy (initiated after ruling out sepsis) failed to provide improvement. The medical course was complicated by multisystem involvement (respiratory failure, cerebral edema, renal failure, coagulopathy, hepatic failure, and thromboembolism). Transthoracic echocardiogram revealed thrombus in the right ventricle, which was the result of the prothrombotic state, and the patient expired on day tenth of hospitalization. Our case describes a unique case of right ventricular thrombosis secondary to macrophage activation syndrome (MAS).
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Affiliation(s)
- Namrata Paul
- Department of Medicine, St. Joseph's University Medical Center/New York Medical College, Paterson, NJ, USA
| | - Cesar Avalos
- Department of Medicine, St. Joseph's University Medical Center/New York Medical College, Paterson, NJ, USA
| | - Elias Estifan
- Department of Medicine, St. Joseph's University Medical Center/New York Medical College, Paterson, NJ, USA
| | - Shelbi Swyden
- St. Joseph's University Medical Center, Paterson, NJ, USA
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Hauch H, Skrzypek S, Woessmann W, Lehmberg K, Ehl S, Speckmann C, Schneck E, Koerholz D, Jux C, Neuhäuser C. Tuberculosis-Associated HLH in an 8-Month-Old Infant: A Case Report and Review. Front Pediatr 2020; 8:556155. [PMID: 33194891 PMCID: PMC7661936 DOI: 10.3389/fped.2020.556155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare immunological disease, which can be mistaken for sepsis easily. Among the infectious causes that may trigger secondary HLH, tuberculosis (TBC), a rather rare pathogen nowadays, is typical. To our knowledge, this is the first case report of an infant suffering from TBC-associated HLH-induced acute respiratory failure who was treated successfully using extracorporeal membrane oxygenation. An 8-month-old boy with fever (over the last 8 wk) and pancytopenia was transferred to our institution with acute respiratory failure and for extracorporeal membrane oxygenation therapy. Bone marrow biopsy revealed hemophagocytosis. Immunological work-up for familial HLH was negative. In a desperate search for the cause of secondary HLH, an interferon-gamma release assay for TBC returned positive. However, microscopy for acid-fast bacteria as well as polymerase chain reaction for TBC were initially negative. Despite this, the child was treated with tuberculostatic therapy. TBC was finally confirmed. The child remained on extracorporeal membrane oxygenation for 28 d. Further work-up showed typical lesions of disseminated TBC. The mother was identified as the source of TBC. The boy presents with mild sequelae (fine motor skills). In infants with suspected septicemia, TBC should be considered as differential diagnosis even if the results are initially negative.
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Affiliation(s)
- Holger Hauch
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Giessen, Giessen, Germany
| | - Susanne Skrzypek
- Department of Pediatric Cardiology and Intensive Care, University Children's Hospital Giessen, Giessen, Germany
| | - Wilhelm Woessmann
- Division of Pediatric Stem Cell Transplantation, University Children's Hospital Hamburg, UKE, Hamburg, Germany
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation, University Children's Hospital Hamburg, UKE, Hamburg, Germany
| | - Stephan Ehl
- Center for Chronic Immunodeficiency, Institute for Immunodeficiency, Medical Center-University of Freiburg, Freiburg, Germany.,Center of Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Carsten Speckmann
- Center for Chronic Immunodeficiency, Institute for Immunodeficiency, Medical Center-University of Freiburg, Freiburg, Germany.,Center of Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Children's Hospital Giessen, Giessen, Germany
| | - Dieter Koerholz
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Giessen, Giessen, Germany
| | - Christian Jux
- Department of Pediatric Cardiology and Intensive Care, University Children's Hospital Giessen, Giessen, Germany
| | - Christoph Neuhäuser
- Department of Pediatric Cardiology and Intensive Care, University Children's Hospital Giessen, Giessen, Germany
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