Prognostic factors of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis in children: Report of the Japan Histiocytosis Study Group
Background Despite several advances in the treatment of Epstein–Barr virus (EBV) in recent years, patients with Epstein–Barr virus‐associated hemophagocytic lymphohistiocytosis (EBV‐HLH) do not always show satisfactory outcomes. We here conducted a nationwide survey in Japan to identify prognostic f...
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Published in | Pediatric blood & cancer Vol. 61; no. 7; pp. 1257 - 1262 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Blackwell Publishing Ltd
01.07.2014
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Despite several advances in the treatment of Epstein–Barr virus (EBV) in recent years, patients with Epstein–Barr virus‐associated hemophagocytic lymphohistiocytosis (EBV‐HLH) do not always show satisfactory outcomes. We here conducted a nationwide survey in Japan to identify prognostic factors of EBV‐HLH in children with this disease in an effort to improve the management and the outcomes of these patients.
Procedure
Between January 2003 and June 2008, we enrolled 98 children younger than 18 years of age who were diagnosed with EBV‐HLH. We then studied the clinical characteristics and laboratory findings at the time of diagnosis with the aim to identify prognostic factors for EBV‐HLH.
Results
The mean age of onset of EBV‐HLH was 3.9 ± 2.8 years. Most of our patients presented with fever, hepatosplenomegaly, lymphadenopathy, and hemophagocytosis of bone marrow. Sixty‐two percent of patients showed T cell clonality, and 97% had EBV infection in either T or natural killer cells. Most patients (60%) were treated with a multi‐agent chemotherapeutic regimen, including corticosteroid, etoposide, and cyclosporine. After initial treatment, 90.3% of patients were in remission, and 7 patients (8.2%) experienced recurrence of EBV infection. Among several prognostic factors, patients with both hyperbilirubinemia (>1.8 mg/dl) and hyperferritinemia (>20,300 ng/ml) at the time of diagnosis had significantly poorer outcomes than those with low serum bilirubin and ferritin levels.
Conclusions
These findings suggest that the therapeutic strategy for children with EBV‐HLH could be tailored according to the laboratory findings at diagnosis. Pediatr Blood Cancer 2014;61:1257–1262. © 2014 Wiley Periodicals, Inc. |
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Bibliography: | Ministry of Health, Labour and Welfare of Japan ark:/67375/WNG-FVDHM6JG-0 istex:CFCE1E3EE1FE143484F15E60757BFA80A7574452 ArticleID:PBC24980 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 |
ISSN: | 1545-5009 1545-5017 |
DOI: | 10.1002/pbc.24980 |