A CHALLENGE IN PEDIATRIC ACUTE LEUKEMIA TREATMENT: UNEXPECTED, PROLONGED CYTOPENIA. IS IT BE CALLLED ‘INCOMPLETE HLH’?

Abstract

Objective: The diagnostic criteria set for HLH may look like symptoms of cancer or a severe bacterial infection common occurring when patients are immunosuppressed due to ongoing chemotherapy. Features similar to immune dysregulation in HLH also occur during pediatric acute leukemias. This immune dysregulation results unexpected cytopenias, fever, and splenomegaly in children with acute leukemia. We aim to analysis the pediatric acute leukemia pateints who had unexpected, prolonged cytopenias, and did not full-fill the HLH-2004 criteria set and received pulse methylprednisolone therapy up to three days Methodology: Data was analyzed retrospectively. The diagnosis of HLH was defined according to the HLH-2004 criteria set but two criterias (NK cell activity and sCD25 level) of HLH diagnosis were not studied due to lack of necessary equipment. Treatment response was defined as increasing neutrophil count above 500/mm3 in patients within the first seven days. Results: 12 patients received steroid for unexpected, prolonged cytopenias. Five or six of six criteria was not found. Four criteria in four, three criteria in five and two criteria in three patients was determined. All patients had cytopenia at least two of three lineages in peripheral blood, one of which was neutropenia. Hemophagocytosis in bone marrow sample was detected in eight patients. Ten patients (87%) recovered within the first seven days. Seven of nine thrombocytopenic patients recovered. Conclusion: In this report, the efficiency of short-term steroid treatment was demostrated in patients with unusual cytopenias who did not full-fill HLH criteria.