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Treatment dilemmas in asymptomatic children with primary hemophagocytic lymphohistiocytosis

Lucchini, G; Marsh, R; Gilmour, K; Worth, A; Nademi, Z; Rao, A; Booth, C; ... Rao, K; + view all (2018) Treatment dilemmas in asymptomatic children with primary hemophagocytic lymphohistiocytosis. Blood , 132 (19) pp. 2088-2096. 10.1182/blood-2018-01-827485. Green open access

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Abstract

Asymptomatic carriers (ACs) of pathogenic biallelic mutations in causative genes for primary hemophagocytic lymphohistiocytosis (HLH) are at high risk of developing life-threatening HLH, which requires allogeneic hematopoietic stem cell transplantation (HSCT) to be cured. There are no guidelines on the management of these asymptomatic patients. We analyzed the outcomes of pairs of index cases (ICs) and subsequently diagnosed asymptomatic family members carrying the same genetic defect. We collected data from 22 HSCT centers worldwide. Sixty-four children were evaluable. ICs presented with HLH at a median age of 16 months. Seven of 32 ICs died during first-line therapy, and 2 are alive after chemotherapy only. In all, 23/32 underwent HSCT, and 16 of them are alive. At a median follow-up of 36 months from diagnosis, 18/32 ICs are alive. Median age of ACs at diagnosis was 5 months. Ten of 32 ACs activated HLH while being observed, and all underwent HSCT: 6/10 are alive and in complete remission (CR). 22/32 ACs remained asymptomatic, and 6/22 have received no treatment and are in CR at a median follow-up of 39 months. Sixteen of 22 underwent preemptive HSCT: 15/16 are alive and in CR. Eight-year probability of overall survival (pOS) in ACs who did not have activated HLH was significantly higher than that in ICs (95% vs 45%; P = .02), and pOS in ACs receiving HSCT before disease activation was significantly higher than in ACs receiving HSCT after HLH activation (93% vs 64%; P = .03). Preemptive HSCT in ACs proved to be safe and should be considered.

Type: Article
Title: Treatment dilemmas in asymptomatic children with primary hemophagocytic lymphohistiocytosis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1182/blood-2018-01-827485
Publisher version: https://doi.org/10.1182/blood-2018-01-827485
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: abdominal compartment syndrome, acute coronary syndromes, american cancer society, american college of surgeons, child, ciliary motility disorders, familial hemophagocytic lymphocytosis, follow-up, hematopoietic stem cell transplantation, chemotherapy regimen
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10111649
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