Recommendations for the management of hemophagocytic lymphohistiocytosis in adults by Paul La Rosée, AnnaCarin Horne, Melissa Hines, Tatiana von Bahr Greenwood,

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Presentation transcript:

Recommendations for the management of hemophagocytic lymphohistiocytosis in adults by Paul La Rosée, AnnaCarin Horne, Melissa Hines, Tatiana von Bahr Greenwood, Rafal Machowicz, Nancy Berliner, Sebastian Birndt, Juana Gil-Herrera, Michael Girschikofsky, Michael B. Jordan, Ashish Kumar, Jan A. M. van Laar, Gunnar Lachmann, Kim E. Nichols, Athimalaipet V. Ramanan, Yini Wang, Zhao Wang, Gritta Janka, and Jan-Inge Henter Blood Volume 133(23):2465-2477 June 6, 2019 ©2019 by American Society of Hematology

Overview of the HLH-94 treatment protocol. Overview of the HLH-94 treatment protocol. Note that dose and frequency adjustments of this protocol are advised for adult patients (see Statement 7). Paul La Rosée et al. Blood 2019;133:2465-2477 ©2019 by American Society of Hematology

Treatment algorithm for adult patients with HLH, including MAS-HLH. Treatment algorithm for adult patients with HLH, including MAS-HLH. The HLH-94 pediatric treatment protocol is the consensus mainstay treatment of newborns, toddlers, and children up to 18 years of age, where genetic causes of HLH are enriched. Individual adaptation regarding the length and dosing of the HLH-94 treatment plan in adults is warranted. Allogeneic hematopoietic stem cell transplant (alloSCT) can cure primary HLH and may be applied in patients with high-risk hematologic malignancy as consolidation treatment or in relapsed HLH after successful salvage treatment. Treatment in adults cannot be standardized and needs tailoring according to the underlying condition and HLH-initiating trigger (infection, malignancy, autoimmune/autoinflammatory, drug induced, other causes). In relapsed/refractory (r/r) HLH, treatment intensification with chemotherapy, use of the anti-CD52 antibody alemtuzumab, cytokine adsorption using filter columns or plasma exchange, off-label treatment with the JAK2 inhibitor ruxolitinib, or the anti–IFN-γ antibody emapalumab have shown reasonable efficacy. BiTE, bispecific T-cell engager; CART, chimeric antigen receptor T cells; CHOP, cyclophosphamide, doxorubicin, vincristine, prednisone; CS, corticosteroids; DEP, doxorubicin, etoposide, methylprednisolone; IVIG, polyvalent immunoglobulins; Pat, patient. *Off-label in EBV-HLH. Paul La Rosée et al. Blood 2019;133:2465-2477 ©2019 by American Society of Hematology