title: Requirement for etoposide in the treatment of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis.
abstract: OBJECTIVE
  We sought to identify the clinical variables most critical to successful treatment of Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis (HLH).
  
  
  METHODS
  Among the factors tested were age at diagnosis (< 2 years or > or = 2 years), time from diagnosis to initiation of treatment with or without etoposide-containing regimens, timing of cyclosporin A (CSA) administration during induction therapy, and the presence or absence of etoposide.
  
  
  RESULTS
  By Kaplan-Meier analysis, the overall survival rate for the entire cohort of 47 patients, most of whom had moderately severe to severe disease, was 78.3% +/- 6.7% (SE) at 4 years. The probability of long-term survival was significantly higher when etoposide treatment was begun less than 4 weeks from diagnosis (90.2% +/- 6.9% v 56.5% +/- 12.6% for patients receiving this agent later or not at all; P <.01, log-rank test). Multivariate analysis with the Cox proportional hazards model demonstrated the independent prognostic significance of a short interval from EBV-HLH diagnosis to etoposide administration (relative risk of death for patients lacking this feature, 14.1; 95% confidence interval, 1.16 to 166.7; P =.04). None of the competing variables analyzed had significant predictive strength in the Cox model. However, concomitant use of CSA with etoposide in a subset of patients appears to have prevented serious complications from neutropenia during the first year of treatment.
  
  
  CONCLUSIONS
  We conclude that early administration of etoposide, preferably with CSA, is the treatment of choice for patients with EBV-HLH.
authors.affiliation: Kyoto City Institute of Health and Environmental Sciences, Japan. shinim95@mbox.kyoto-inet.or.jp
authors.forename: S
authors.initials: S
authors.lastname: Imashuku
authors.forename: K
authors.initials: K
authors.lastname: Kuriyama
authors.forename: T
authors.initials: T
authors.lastname: Teramura
authors.forename: E
authors.initials: E
authors.lastname: Ishii
authors.forename: N
authors.initials: N
authors.lastname: Kinugawa
authors.forename: M
authors.initials: M
authors.lastname: Kato
authors.forename: M
authors.initials: M
authors.lastname: Sako
authors.forename: S
authors.initials: S
authors.lastname: Hibi
mesh_terms: D000293:Adolescent; D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D015616:Histiocytosis, Non-Langerhans-Cell / Q000188:drug therapy* / Q000401:mortality / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide; D016572:Cyclosporine