Patients with Hemophagocytic Lymphohistiocytosis Who Need Intensive Care Can Be Successfully Rescued by Timely Using Etoposide-Based HLH Regimens

Abstract

Kebing Lv,1,* Xiaoye Cheng,1– 3,* Yulan Zhou,1– 3 Min Yu,1– 3 Shixuan Wang,1– 3 Huimin Shen,1 Fei Li1– 3 1Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 2Jiangxi Clinical Research Center for Hematologic Disease, Nanchang, People’s Republic of China; 3Institute of Lymphoma and Myeloma, Nanchang University, Nanchang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fei Li, Email [email protected]: Hemophagocytic lymphohistiocytosis (HLH) patients who need intensive care usually have multiple organ failure and poor prognosis. However, the clinical characteristics, therapeutic efficacy and outcome in these critically ill HLH patients have remained unclear.Methods: We performed a retrospective study of 50 critically ill HLH patients from September 2013 to October 2022. Patients’ information was collected, and the overall survival rate was estimated.Results: Fifty HLH patients need intensive care, and the median sequential organ failure assessment (SOFA) score was 8. 66.00% patients had septic shock, 60.00% had disseminated intravascular coagulation (DIC) and 56.00% had acute respiratory distress syndrome (ARDS). 64.00% patients needed vasoactive drugs, 60.00% needed invasive or non-invasive positive pressure mechanical ventilation, and 12.00% needed continuous renal replacement therapy (CRRT). Among 18 patients received the etoposide-based regimens, the median time for 17 patients to remove ECG monitoring was 13 days (4– 30 days); the median time to remove respiratory support in 10 patients was 8.5 days (4– 21 days); the median time for 5 patient to convert from dominant DIC to non-dominant DIC was 4 days (1– 14 days) and the median time for 6 patients to stop using vasoactive drugs was 10 days (2– 14 days). After 4 weeks of treatment, 7 patients were evaluated as NR, 6 achieved PR, and 5 could not be evaluated. The ORR was 55.56%. Up to the last follow-up, the OS rate of patients receiving etoposide-based regimens was 66.67%. In contrast, all 32 HLH patients in other groups died. Univariate analysis showed that PCT > 0.5 ug/L, PT prolonged > 6 s, TBil > 25umol/L, respiratory failure, renal failure, liver failure and did not receive etoposide- based regimens were the negative factors affecting survival (P = 0.001, 0.017, 0.043, 0.001, 0.000, 0.029, 0.000).Conclusion: HLH patients who need intensive care timely used etoposide-based HLH regimens might rescue critically ill patients successfully.Keywords: hemophagocytic lymphohistiocytosis, etoposide-based treatment, critically ill patients, prognosis

Keywords

• hemophagocytic lymphohistiocytosis
• etoposide-based treatment
• critically ill patients
• prognosis