title: Etoposide-containing conditioning regimen reduces the occurrence of hemophagocytic lymphohistiocytosis after SCT.
abstract: Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease of severe hyperinflammation caused by uncontrolled proliferation of activated lymphocytes and macrophages that secrete high amounts of inflammatory cytokines. HLH occurring after SCT is difficult to diagnose. It is characterized by severe clinical manifestations and high mortality. Despite current therapeutic approaches, outcomes remain poor. We analyzed the incidence and risk factors of HLH after SCT and the response to treatment and prognosis of 554 patients with HLH after SCT. The cumulative incidence of HLH after SCT was 4.3% (24/554). Use of etoposide in the conditioning regimen was only factor that reduced HLH after SCT (P=0.027). All patients who received autologous transplantation were successfully treated. Patients with liver dysfunction (for example, high total bilirubin level, prolonged prothrombin time and high level of fibrinogen degradation products) had a poor response to treatment for HLH. Physicians should be cautious of HLH, while not using etoposide for conditioning regimen.
authors.affiliation: Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Kobayashi
authors.affiliation: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.affiliation: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hashino
authors.affiliation: Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ota
authors.affiliation: Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Torimoto
authors.affiliation: Department of Hematology, Asahikawa City Hospital, Asahikawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kakinoki
authors.affiliation: Department of Hematology, Sapporo City General Hospital, Sapporo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Hematology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kurosawa
authors.affiliation: Department of Pediatrics, Sapporo Medical College, Sapporo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Hatakeyama
authors.affiliation: Department of Hematology, KKR Sapporo Medical Center, Tonan Hospital, Sapporo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Haseyama
authors.affiliation: Department of Hematology, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Department of Hematology, Hokkaido P.W.F.A.C Asahikawa-Kosei General Hospital, Asahikawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Palliative Care Medicine, Hokkaido P.W.F.A.C Sapporo-Kosei General Hospital, Sapporo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fukuhara
mesh_terms: D000293:Adolescent; D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide
references.citation: Bone Marrow Transplant. 2007 Oct;40(7):701-3
references.pmid: 17646843
references.citation: Int J Hematol. 2004 Dec;80(5):467-9
references.pmid: 15646662
references.citation: Int J Hematol. 2007 Dec;86(5):466-7
references.pmid: 18192120
references.citation: Int J Hematol. 2011 Apr;93(4):551-554
references.pmid: 21380927
references.citation: Bone Marrow Transplant. 1998 Feb;21(3):301-3
references.pmid: 9489656
references.citation: Arthritis Res Ther. 2012 Jun 08;14(3):213
references.pmid: 22682420
references.citation: Bone Marrow Transplant. 2006 Apr;37(8):797-8
references.pmid: 16518425
references.citation: Int J Hematol. 2000 Aug;72(2):243-6
references.pmid: 11039676
references.citation: Bone Marrow Transplant. 1990 Nov;6(5):349-52
references.pmid: 2291998
references.citation: Bone Marrow Transplant. 2005 Feb;35(4):415-7
references.pmid: 15640826
references.citation: Bone Marrow Transplant. 2007 Nov;40(10):995-6
references.pmid: 17768388
references.citation: Leukemia. 1996 Feb;10(2):197-203
references.pmid: 8637226
references.citation: Nature. 2006 Nov 2;444(7115):110-4
references.pmid: 17080092
references.citation: Int J Hematol. 2009 Apr;89(3):368-373
references.pmid: 19252966
references.citation: Bone Marrow Transplant. 2002 May;29(9):799-801
references.pmid: 12040480
references.citation: Blood Rev. 2007 Sep;21(5):245-53
references.pmid: 17590250
references.citation: Am J Pediatr Hematol Oncol. 1991 Fall;13(3):305-9
references.pmid: 1665315
references.citation: Int J Hematol. 2007 Jul;86(1):58-65
references.pmid: 17675268
references.citation: Bone Marrow Transplant. 1998 Mar;21(6):623-5
references.pmid: 9543068
references.citation: Bone Marrow Transplant. 1987 Jun;2(1):99-102
references.pmid: 3139115
references.citation: Bone Marrow Transplant. 1998 Dec;22(12):1219-22
references.pmid: 9894728
references.citation: Bone Marrow Transplant. 2006 Nov;38(10):709-10
references.pmid: 17013422
references.citation: Int J Hematol. 2001 Feb;73(2):262-5
references.pmid: 11372742
references.citation: Br J Haematol. 2009 Nov;147(4):543-53
references.pmid: 19709082