4.5 Review

Cytokine Storm Syndrome

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Article Rheumatology

Severe delayed hypersensitivity reactions to IL-1 and IL-6 inhibitors link to common HLA-DRB1*15 alleles

Vivian E. Saper et al.

Summary: Drug reaction with eosinophilia and systemic symptoms (DRESS) can occur in Still's disease patients treated with IL-1/IL-6 inhibitors, with features such as eosinophilia, liver enzyme elevation, and persistent rash. HLA-DRB1*15 haplotypes are significantly enriched in Still's disease with DRESS. Pre-prescription HLA typing and vigilance for serious reactions to these drugs are recommended.

ANNALS OF THE RHEUMATIC DISEASES (2022)

Article Hematology

An improved index for diagnosis and mortality prediction in malignancy-associated hemophagocytic lymphohistiocytosis

Adi Zoref-Lorenz et al.

Summary: This study found that the optimized HLH inflammatory (OHI) index, which combines levels of soluble CD25 and ferritin, can effectively diagnose HLH and predict mortality in patients with HMs. Additionally, the index can identify high-risk patients who may not be diagnosed with HLH according to traditional criteria.
Article Rheumatology

Clinical spectrum and therapeutic management of systemic lupus erythematosus-associated macrophage activation syndrome: a study of 20 Moroccan adult patients

Ammouri Wafa et al.

Summary: This study aimed to investigate the clinical and laboratory manifestations, triggers, treatment, and outcome of macrophage activation syndrome (MAS) complicating systemic lupus erythematosus (SLE). The study found that fever, splenomegaly, lymphadenopathy, profound cytopenia, hyperferritinemia, hypertriglyceridemia, high SLEDAI, and H-Score were associated with MAS. Early diagnosis and urgent therapeutic management improved the overall prognosis.

CLINICAL RHEUMATOLOGY (2022)

Review Obstetrics & Gynecology

Management of hemophagocytic lymphohistiocytosis in pregnancy: Case series study and literature review

Congcong Liu et al.

Summary: This study retrospectively analyzed the clinical characteristics and treatment options of 13 patients with hemophagocytic lymphohistiocytosis (HLH) during pregnancy. The results showed that early diagnosis and treatment are crucial for maternal survival, and corticosteroids are the preferred treatment for most patients.

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (2022)

Review Rheumatology

Janus kinase-targeting therapies in rheumatology: a mechanisms-based approach

Yoshiya Tanaka et al.

Summary: This Review discusses the therapeutic use of Janus kinase inhibitors in autoimmune rheumatic diseases, highlighting their disease-specific mechanisms of action. JAK inhibitors suppress intracellular signaling mediated by multiple cytokines, offering potential treatment options for a range of immune and inflammatory disorders.

NATURE REVIEWS RHEUMATOLOGY (2022)

Article Allergy

Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): Distinct from Kawasaki disease or part of the same spectrum?

Maria Santaniello et al.

Summary: One of the most challenging and intriguing phenomena during the COVID-19 pandemic is the multisystem inflammatory syndrome in children, which shares similarities with Kawasaki disease but also presents with different symptoms.

PEDIATRIC ALLERGY AND IMMUNOLOGY (2022)

Article Rheumatology

Who Would Have Predicted Multisystem Inflammatory Syndrome in Children?

Daniel D. Reiff et al.

Summary: This review provides an in-depth analysis of multisystem inflammatory disease in children (MIS-C) following COVID-19. It discusses the clinical findings, pathophysiology, imaging and laboratory studies, treatment algorithms, and disease outcomes. MIS-C can be challenging to diagnose due to its non-specific presentation, but accurate diagnosis can be achieved through common laboratory features, imaging findings, and historical clues, enabling appropriate treatment with therapies such as IVIG. Aggressive treatment leads to good outcomes, and longitudinal studies shed light on long-term cardiac sequelae and recovery.

CURRENT RHEUMATOLOGY REPORTS (2022)

Article Immunology

A Novel Prognostic Index Model for Adult Hemophagocytic Lymphohistiocytosis: A Multicenter Retrospective Analysis in China

Ziyuan Shen et al.

Summary: This study developed a prognostic model for adult HLH in China, providing a feasible and accurate stratification system for individualized treatment strategy. The model can help improve the prognosis of patients.

FRONTIERS IN IMMUNOLOGY (2022)

Review Hematology

Malignancy-associated haemophagocytic lymphohistiocytosis

Audi Setiadi et al.

Summary: Haemophagocytic lymphohistiocytosis (HLH) is an inflammatory syndrome that can occur with cancer or immune-activating therapies for cancer. Familial HLH is characterized by uncontrolled activation of macrophages and cytotoxic T cells, while the pathophysiology of malignancy-associated HLH is not well understood. Distinguishing HLH from cancer-related abnormalities is challenging and emerging diagnostic tools are discussed. Targeted therapy, including cytokine blockade and JAK-STAT inhibition, may improve outcomes. The framework of cytokine storm syndrome can help understand malignancy-associated HLH.

LANCET HAEMATOLOGY (2022)

Review Hematology

Haemophagocytic lymphohistiocytosis and Epstein-Barr virus: a complex relationship with diverse origins, expression and outcomes

Nader Kim El-Mallawany et al.

Summary: Epstein-Barr virus (EBV) is associated with various presentations of haemophagocytic lymphohistiocytosis (HLH), which can be life-threatening. Patients may have genetic defects or underlying infection/malignancy, with EBV playing a significant role. Increased awareness and understanding of EBV-related complications are crucial for improving survival rates.

BRITISH JOURNAL OF HAEMATOLOGY (2022)

Article Rheumatology

Cytokine profile, ferritin and multi-visceral involvement characterize macrophage activation syndrome during adult-onset Still's disease

Piero Ruscitti et al.

Summary: The study found that in patients with adult-onset Still's disease complicated by macrophage activation syndrome, levels of cytokines (IL-1, IL-6, IFN-gamma, etc.) and inflammatory markers (ferritin) were elevated. Analysis of circulating immune cells in MAS patients showed an increase in 'classical monocytes' and a reduction in total NK cells. A total of 3477 IFN-related genes were identified in AOSD synovial tissues.

RHEUMATOLOGY (2022)

Review Infectious Diseases

Hemophagocytic lymphohistiocytosis: An unusual presentation of disseminated tuberculosis: A case report and literature review

Poornachandra et al.

Summary: This article presents a case of acquired HLH associated with Mycobacterial tuberculosis infection, emphasizing the importance of early diagnosis and treatment for improving the clinical outcome of the patient.

JOURNAL OF CLINICAL TUBERCULOSIS AND OTHER MYCOBACTERIAL DISEASES (2022)

Article Oncology

Diagnostic strategy for trigger identification in severe reactive hemophagocytic lymphohistiocytosis: A diagnostic accuracy study

Jean-Jacques Tudesq et al.

Summary: Management of reactive hemophagocytic lymphohistiocytosis (rHLH) requires early recognition, identification of triggers, and adequate treatment to reduce mortality. Tissue biopsies have a high diagnostic yield in identifying triggers in severe rHLH cases. While splenectomy carries a procedural risk, it can be reserved for cases where diagnostic uncertainty persists. Early initiation of appropriate therapy based on trigger identification leads to better outcomes in patients with rHLH.

HEMATOLOGICAL ONCOLOGY (2021)

Article Rheumatology

Predicting Macrophage Activation Syndrome in Childhood-onset Systemic Lupus Erythematosus Patients at Diagnosis

Maya Gerstein et al.

Summary: The study aimed to differentiate macrophage activation syndrome (MAS) from active childhood-onset systemic lupus erythematosus (cSLE) and generated decision rules based on clinical and laboratory features. Recursive partitioning identified serum ferritin as the best discriminator between MAS and non-MAS patients. Validation in independent cohorts is needed to confirm the findings.

JOURNAL OF RHEUMATOLOGY (2021)

Article Medicine, General & Internal

Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19

A. C. Kalil et al.

Summary: Combination treatment with baricitinib plus remdesivir was superior to remdesivir alone in reducing recovery time and accelerating improvement in clinical status among patients with Covid-19, notably among those receiving high-flow oxygen or noninvasive ventilation. The combination was associated with fewer serious adverse events.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

Review Immunology

Use of the JAK Inhibitor Ruxolitinib in the Treatment of Hemophagocytic Lymphohistiocytosis

Camille Keenan et al.

Summary: Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome driven by overactive T cells and macrophages that abundantly secrete pro-inflammatory cytokines. Etoposide-based regimens have reduced mortality associated with HLH, but the 5-year survival rate remains low. Novel cytokine-directed therapies, such as ruxolitinib, are being studied to improve outcomes in HLH.

FRONTIERS IN IMMUNOLOGY (2021)

Article Immunology

Usefulness of Interleukin-18 as a Diagnostic Biomarker to Differentiate Adult-Onset Still's Disease With/Without Macrophage Activation Syndrome From Other Secondary Hemophagocytic Lymphohistiocytosis in Adults

Toshihiko Shiga et al.

Summary: The study suggests that IL-18 could be a useful biomarker for the differential diagnosis of AOSD and adult HLH. Serum IL-18 levels were significantly higher in the AOSD group compared to the adult HLH group, and were closely correlated with ferritin, soluble interleukin-2 receptor (sIL-2R), and other laboratory data.

FRONTIERS IN IMMUNOLOGY (2021)

Editorial Material Medicine, Research & Experimental

A perspective on the potential detrimental role of inflammation in pig orthotopic heart xenotransplantation

Charles P. Thompson et al.

Summary: The inflammatory response following surgical procedures and xenograft exposure may have detrimental effects on pig heart graft function and recipient baboon pulmonary function, as well as impacting immune response to the graft. Strategies to reduce the inflammatory response, such as white blood cell filtration and immunosuppressive therapy, could potentially improve outcomes of genetically engineered pig heart transplantation.

XENOTRANSPLANTATION (2021)

Review Medicine, General & Internal

Successful ruxolitinib administration for a patient with steroid-refractory idiopathic pneumonia syndrome following hematopoietic stem cell transplantation: A case report and literature review

Dan Tomomasa et al.

Summary: IPS is an acute lung complication that occurs after HSCT, and ruxolitinib may be an alternative treatment option for patients with severe IPS, as shown in a case of a myelodysplastic syndrome patient who had undergone a second HSCT.

CLINICAL CASE REPORTS (2021)

Article Pediatrics

Kawasaki Disease and Systemic Juvenile Idiopathic Arthritis - Two Ends of the Same Spectrum

Ellen Go et al.

Summary: This study describes the disease course of a small proportion of patients with both Kawasaki disease and systemic juvenile idiopathic arthritis, characterized by refractory Kawasaki disease, high prevalence of coronary artery dilatation, and shared immunopathology potentially linking the two conditions.

FRONTIERS IN PEDIATRICS (2021)

Article Hematology

Characterization of HLH-like manifestations as a CRS variant in CD22 CAR T cells

Daniel A. Lichtenstein et al.

Summary: In a subset of patients with cytokine release syndrome (CRS), chimeric antigen receptor (CAR) T-cell toxicities resembling hemophagocytic lymphohistiocytosis (HLH) can occur, known as carHLH. This study comprehensively characterized the manifestations and timing of carHLH, highlighting factors such as preinfusion natural killer cell lymphopenia and higher bone marrow T-cell:NK cell ratio associated with its development. Additionally, carHLH was characterized by persistent elevation of HLH-associated inflammatory cytokines following CAR T-cell expansion.
Article Medicine, General & Internal

Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19 AMeta-analysis

Manu Shankar-Hari et al.

Summary: This study identified 27 clinical trials and found that the use of IL-6 antagonists was associated with lower 28-day all-cause mortality in patients hospitalized for COVID-19 compared to usual care or placebo. Different risk effects were observed between tocilizumab and sarilumab, increasing understanding of the treatment with these drugs.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

Article Biochemistry & Molecular Biology

Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial

Evdoxia Kyriazopoulou et al.

Summary: The SAVE-MORE phase 3 study demonstrated the efficacy of anakinra, an IL-1 alpha/beta inhibitor, in patients with COVID-19 and high serum levels of soluble plasminogen activator receptor, showing significant reduction in clinical deterioration and decreased 28-day mortality.

NATURE MEDICINE (2021)

Editorial Material Biochemistry & Molecular Biology

Calming the cytokine storm in COVID-19

Randy Q. Cron et al.

Summary: Cytokine blockade can improve the survival rate of COVID-19 patients at risk of respiratory failure, with timing and patient selection being crucial factors.

NATURE MEDICINE (2021)

Article Rheumatology

Performance of Cytokine Storm Syndrome Scoring Systems in Pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children

Daniel D. Reiff et al.

Summary: This study evaluated the effectiveness of different scoring systems in identifying patients with cytokine storm syndrome in pediatric COVID-19 and MIS-C. Some systems were found to be more suitable for identifying CSS, but existing scoring systems might not fully capture the breadth of the disease processes in these two conditions.

ACR OPEN RHEUMATOLOGY (2021)

Letter Hematology

Ruxolitinib for refractory/relapsed hemophagocytic lymphohistiocytosis

Jingshi Wang et al.

HAEMATOLOGICA (2020)

Article Rheumatology

Benefit of Anakinra in Treating Pediatric Secondary Hemophagocytic Lymphohistiocytosis

Esraa M. Eloseily et al.

ARTHRITIS & RHEUMATOLOGY (2020)

Article Medicine, General & Internal

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang et al.

LANCET (2020)

Review Genetics & Heredity

The genetics of macrophage activation syndrome

Grant S. Schulert et al.

GENES AND IMMUNITY (2020)

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Clinical and immunological features of severe and moderate coronavirus disease 2019

Guang Chen et al.

JOURNAL OF CLINICAL INVESTIGATION (2020)

Article Rheumatology

On the Alert for Cytokine Storm: Immunopathology in COVID-19

Lauren A. Henderson et al.

ARTHRITIS & RHEUMATOLOGY (2020)

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Emapalumab in Children with Primary Hemophagocytic Lymphohistiocytosis

F. Locatelli et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

Article Allergy

Highways to hell: Mechanism-based management of cytokine storm syndromes

Scott W. Canna et al.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2020)

Review Medicine, General & Internal

Cytokine Storm

David C. Fajgenbaum et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

Article Hematology

ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells

Daniel W. Lee et al.

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION (2019)

Review Critical Care Medicine

Extracorporeal life support and systemic inflammation

Abdulrahman Al-Fares et al.

INTENSIVE CARE MEDICINE EXPERIMENTAL (2019)

Article Medicine, General & Internal

Lamotrigine-induced hemophagocytic lymphohistiocytosis with Takotsubo cardiomyopathy: a case report

Jenny Y. Zhou et al.

JOURNAL OF MEDICAL CASE REPORTS (2019)

Letter Allergy

Life-threatening NLRC4-associated hyperinflammation successfully treated with IL-18 inhibition

Scott W. Canna et al.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2017)

Review Rheumatology

Cytokine Storm Syndrome: Looking Toward the Precision Medicine Era

Edward M. Behrens et al.

ARTHRITIS & RHEUMATOLOGY (2017)

Review Hematology

Ehrlichia-Induced Hemophagocytic Lymphohistiocytosis: A Case Series and Review of Literature

Zaher K. Otrock et al.

BLOOD CELLS MOLECULES AND DISEASES (2015)

Article Immunology

Failed CTL/NK cell killing and cytokine hypersecretion are directly linked through prolonged synapse time

Misty R. Jenkins et al.

JOURNAL OF EXPERIMENTAL MEDICINE (2015)

Editorial Material Rheumatology

Does Viral Hemorrhagic Fever Represent Reactive Hemophagocytic Syndrome?

Randy Q. Cron et al.

JOURNAL OF RHEUMATOLOGY (2015)

Article Medicine, General & Internal

Reactive Hemophagocytic Syndrome in Adults: A Retrospective Analysis of 162 Patients

Sebastien Riviere et al.

AMERICAN JOURNAL OF MEDICINE (2014)

Article Immunology

Ebola Hemorrhagic Fever: Novel Biomarker Correlates of Clinical Outcome

Anita K. McElroy et al.

JOURNAL OF INFECTIOUS DISEASES (2014)

Article Medicine, General & Internal

Prognostic Factors and Outcomes of Adults With Hemophagocytic Lymphohistiocytosis

Sameer A. Parikh et al.

MAYO CLINIC PROCEEDINGS (2014)

Review Rheumatology

Reaching the Threshold: A Multilayer Pathogenesis of Macrophage Activation Syndrome

Raffaele Strippoli et al.

JOURNAL OF RHEUMATOLOGY (2013)

Review Oncology

HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis

Jan-Inge Henter et al.

PEDIATRIC BLOOD & CANCER (2007)