[A multicenter retrospective analysis of diagnosis and treatment of 72 hemophagocytic syndrome patients.].
OBJECTIVE
To explore early diagnosis of hemophagocytic syndrome (HPS) and effective treatment.


METHODS
A multicenter retrospective study was carried out to analyze the causes, clinical features, laboratory findings, treatment and clinical outcomes of 72 patients with HPS.


RESULTS
Among the 72 patients, EBV infection and T lymphoma were the most common initiating diseases. The most common clinical features were persistent fever (100%) and splenomegaly (83.3%). The diagnostic sensitivity was persistent fever (100%), peripheral cytopenia in two or more lineages (97.2%), high concentration of serum soluble CD25 (93.1%) and low NK cell activity (94.4%). The median percentage of serum glycosylated ferritin was significantly lower in patients in HPS group \[(17.4 +/- 16.0)%\] than in control group \[(53.6 +/- 13.3)%\] (P < 0.01). And the median level of serum TNF-alpha was significantly higher in patients group \[(143.2 +/- 64.8) microg/L\] than in controls \[(66.9 +/- 19.4) microg/L\] (P < 0.01). Hepatic dysfunction was seen in most patients (83.6%) mainly manifested as elevated liver enzymes and hypoalbuminemia. The 15-week total survival rate was 46.8% in 47 treated patients, and was 63% in 27 treated with fludarabine in combination with high dose methylprednisolone. The platelet count and fibrinogen level were significantly lower in death group than in survival group.


CONCLUSIONS
The diagnostic sensitivities of presistent fever, peripheral cytopenia in two or more lineages, high concentration of serum soluble CD25 and low NK cell activity are relatively high and lacking hemophagocytosis does not exclude the diagnosis. Low percentage of glycosylated ferritin and high concentration of TNF-alpha would be helpful to the diagnosis. High dose methylprednisolone combined with fludarabine is an effective therapy. Platelet count and fibrinogen level are poor prognostic factors for HPS.
Wang
Yi-Ni
YN
Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Wang
Zhao
Z
Wu
Lin
L
Cen
Xi-Nan
XN
Li
Bo-Tao
BT
Ning
Feng
F
Duan
Xue-Zhang
XZ
Li
Juan
J
D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis; D008775:Methylprednisolone; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha
D014409:Tumor Necrosis Factor-alpha; D008775:Methylprednisolone