Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
Volume 6, Issue 5, Pages 1508-1517Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jaip.2018.05.031
Keywords
Hemophagocytic lymphohistiocytosis; Treatment; Consensus recommendations; Etoposide; Bone marrow transplantation
Categories
Funding
- Deutsche Forschungsgemeinschaft [SFB1160]
- Bundesministerium fur Bildung und Forschung [01 EO 0803]
- Kinderkrebsstiftung
- Swedish Children's Cancer Foundation
- Swedish Cancer Foundation
- Swedish Research Council
- Cancer and Allergy Foundation of Sweden
- Stockholm County Council (ALF project)
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Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome requiring aggressive immunosuppressive therapy. Following 2 large international studies mainly targeting pediatric patients with familial disease and patients without underlying chronic or malignant disease, the HLH-94 protocol is recommended as the standard of care when using etoposide-based therapy by the Histiocyte Society. However, in clinical practice, etoposide-based therapy has been widely used beyond the study inclusion criteria, including older patients and patients with underlying diseases (secondary HLH). Many questions remain around these extended indications and published reports do not address several practical issues. To tackle these concerns, the HLH Steering Committee of the Histiocyte Society decided to issue guidance for use of the HLH-94 protocol. The group convened in a structured consensus finding process to define recommendations that are based largely on expert opinion backed up by available data from the literature. The recommendations address all main elements of HLH-94 including corticosteroids, cyclosporin, etoposide, intrathecal therapy, and hematopoietic stem cell transplantation (HSCT) and consider various forms of HLH and all age groups. Aspects covered include indications, applications, dosing, side effects, duration of therapy, salvage therapy, and HSCT. These recommendations aim to provide a framework to guide treatment decisions in this severe disease. (C) 2018 American Academy of Allergy, Asthma & Immunology
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