Efficacy of Moderately Dosed Etoposide in Macrophage Activation Syndrome-Hemophagocytic Lymphohistiocytosis
© 2021 The Journal of Rheumatology..
OBJECTIVE: Macrophage activation syndrome (MAS) constitutes 1 subtype of the hyperinflammatory syndrome hemophagocytic lymphohistiocytosis (HLH), and the term MAS-HLH was recently proposed for HLH with underlying autoimmune/autoinflammatory conditions. The mortality of MAS-HLH has been estimated at 5-10%. Here we report our experiences with moderately dosed etoposide in severe MAS-HLH; the objective was to effectively reduce severe hyperinflammatory activity with limited side effects.
METHODS: In addition to conventional antiinflammatory treatment, moderately dosed etoposide was administered to 7 children affected by rapidly progressing MAS-HLH with central nervous system (n = 5) and/or pulmonary (n = 5) involvement. Three had underlying systemic juvenile idiopathic arthritis (sJIA), 2 had atypical sJIA (no arthritis at diagnosis), and 2 had systemic lupus erythematosus. We performed lymphocyte cytotoxicity analyses in all 7 and genetic analyses in 6.
RESULTS: All children promptly responded to moderately dosed etoposide (50-100 mg/m2 once weekly), added to conventional MAS-HLH treatment that was considered insufficient. The mean accumulated etoposide dose was 671 mg/m2 (range 300-1050 mg/m2) as compared to 1500 mg/m2 recommended in the first 8 weeks of the HLH-94/HLH-2004 protocols. One child developed neutropenic fever and another neutropenic sepsis (neutrophils 0.3 × 109/L at therapy onset). Five of 7 children had low percentages (< 5%) of circulating natural killer (NK) cells prior to or in association with diagnosis; NK cell activity was pathologically low in 2 of 5 children studied. Disease-causing variants in HLH-associated genes were not found. All children were alive at latest follow-up (2-9 yrs after onset); neurological symptoms had normalized in 4 of 5 affected children.
CONCLUSION: Moderately dosed etoposide may be beneficial in severe and/or refractory MAS-HLH.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:48 |
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| Enthalten in: |
The Journal of rheumatology - 48(2021), 10 vom: 15. Okt., Seite 1596-1602 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Horne, AnnaCarin [VerfasserIn] |
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| Links: |
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| Themen: |
6PLQ3CP4P3 |
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| Anmerkungen: |
Date Completed 21.10.2021 Date Revised 21.10.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.3899/jrheum.200941 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM321489500 |
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| 100 | 1 | |a Horne, AnnaCarin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Efficacy of Moderately Dosed Etoposide in Macrophage Activation Syndrome-Hemophagocytic Lymphohistiocytosis |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 21.10.2021 | ||
| 500 | |a Date Revised 21.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 The Journal of Rheumatology. | ||
| 520 | |a OBJECTIVE: Macrophage activation syndrome (MAS) constitutes 1 subtype of the hyperinflammatory syndrome hemophagocytic lymphohistiocytosis (HLH), and the term MAS-HLH was recently proposed for HLH with underlying autoimmune/autoinflammatory conditions. The mortality of MAS-HLH has been estimated at 5-10%. Here we report our experiences with moderately dosed etoposide in severe MAS-HLH; the objective was to effectively reduce severe hyperinflammatory activity with limited side effects | ||
| 520 | |a METHODS: In addition to conventional antiinflammatory treatment, moderately dosed etoposide was administered to 7 children affected by rapidly progressing MAS-HLH with central nervous system (n = 5) and/or pulmonary (n = 5) involvement. Three had underlying systemic juvenile idiopathic arthritis (sJIA), 2 had atypical sJIA (no arthritis at diagnosis), and 2 had systemic lupus erythematosus. We performed lymphocyte cytotoxicity analyses in all 7 and genetic analyses in 6 | ||
| 520 | |a RESULTS: All children promptly responded to moderately dosed etoposide (50-100 mg/m2 once weekly), added to conventional MAS-HLH treatment that was considered insufficient. The mean accumulated etoposide dose was 671 mg/m2 (range 300-1050 mg/m2) as compared to 1500 mg/m2 recommended in the first 8 weeks of the HLH-94/HLH-2004 protocols. One child developed neutropenic fever and another neutropenic sepsis (neutrophils 0.3 × 109/L at therapy onset). Five of 7 children had low percentages (< 5%) of circulating natural killer (NK) cells prior to or in association with diagnosis; NK cell activity was pathologically low in 2 of 5 children studied. Disease-causing variants in HLH-associated genes were not found. All children were alive at latest follow-up (2-9 yrs after onset); neurological symptoms had normalized in 4 of 5 affected children | ||
| 520 | |a CONCLUSION: Moderately dosed etoposide may be beneficial in severe and/or refractory MAS-HLH | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a etoposide | |
| 650 | 4 | |a hemophagocytic lymphohistiocytosis | |
| 650 | 4 | |a juvenile idiopathic arthritis | |
| 650 | 4 | |a macrophage activation syndrome | |
| 650 | 4 | |a systemic lupus erythematosus | |
| 650 | 7 | |a Etoposide |2 NLM | |
| 650 | 7 | |a 6PLQ3CP4P3 |2 NLM | |
| 700 | 1 | |a von Bahr Greenwood, Tatiana |e verfasserin |4 aut | |
| 700 | 1 | |a Chiang, Samuel C C |e verfasserin |4 aut | |
| 700 | 1 | |a Meeths, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Björklund, Caroline |e verfasserin |4 aut | |
| 700 | 1 | |a Ekelund, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Erensjö, Peter |e verfasserin |4 aut | |
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| 700 | 1 | |a Hagelberg, Stefan |e verfasserin |4 aut | |
| 700 | 1 | |a Bryceson, Yenan T |e verfasserin |4 aut | |
| 700 | 1 | |a Andersson, Ulf |e verfasserin |4 aut | |
| 700 | 1 | |a Henter, Jan-Inge |e verfasserin |4 aut | |
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