Multicenter study of combination DEP regimen as a salvage therapy for adult refractory hemophagocytic lymphohistiocytosis.
Hemophagocytic lymphohistiocytosis (HLH) is a refractory immune disorder with a significant risk of death. Although standard therapy has dramatically improved survival in HLH patients, approximately 30%, especially adults, show no response to current treatment strategies. This prospective study aimed to investigate the efficacy of liposomal doxorubicin treatment combined with etoposide and methylprednisolone (doxorubicin-etoposide-methylprednisolone; DEP) as a salvage therapy for adult refractory HLH. Adult patients who did not achieve at least partial response 2 weeks after initial standard HLH therapy were enrolled in this study between June 2013 and June 2014. Response to salvage therapy was assessed at 2 and 4 weeks after initiation of DEP therapy and patients were followed until death or until November 2014. Sixty-three refractory HLH patients were enrolled, including 29 cases of lymphoma-associated HLH, 22 cases of Epstein-Barr virus-associated HLH, and 4 cases of familial HLH. There were 8 cases with unknown underlying diseases. Seventeen cases (27.0%) achieved complete response and 31 cases (49.2%) achieved partial response. The overall response was 76.2% (48/63). Patients who showed no response to DEP died within 4 weeks after salvage therapy. Twenty-nine of the 48 patients who achieved partial or complete response survived to subsequent chemotherapy, allogenic hematopoietic stem cell transplantation, or splenectomy. Our study suggests that DEP regimen is an effective salvage regimen for adult refractory HLH, which can prolong patient survival as we continue to understand the responsible mechanisms and bridge the gap between HLH and its underlying diseases. This study was registered in the Chinese Clinical Trials Registry Platform (http://www.chictr.org.cn/) as ChiCTR-IPC-14005514.
Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
Yini
Y
Wang
Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
Wenqiu
W
Huang
Department of Transplatation, Affiliated Hospital Academy of Military Medical Sciences, Beijing, China;
Liangding
L
Hu
Department of Hematology, Peking University First Hospital, Beijing, China;
Xinan
X
Cen
Department of Hematology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China;
Lihong
L
Li
Department of Hematology, Peking University Third Hospital, Beijing, China; and.
Jijun
J
Wang
Department of Hematology, Navy General Hospital, Beijing, China.
Jianliang
J
Shen
Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
Na
N
Wei
Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
Zhao
Z
Wang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate
D005047:Etoposide; D002945:Cisplatin; D011241:Prednisone