Hemophagocytic lymphohistiocytosis:Recent progress in the pathogenesis,diagnosis and treatment

• 作者: Shinsaku Imashuku
• 来源期刊: 世界血液学杂志
• 学科: 医学
• 关键词: ALEMTUZUMAB Anti-thymocyte globulin Cyclosporine A Epstein-Barr virus Etoposide Hematopoietic STEM-CELL transplantation HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS Hereditary diseases IMMUNOCHEMOTHERAPY Intravenous immunoglobulin Molecular diagnosis Rituximab Steroids
• 年，卷（期）: 2014,（3）
• 页码范围: 71-84
• 页数: 14页
• 分类号: R

摘要

Hemophagocytic lymphohistiocytosis(HLH)is a hyperinflammatory syndrome that develops as a primary(familial/hereditary)or secondary(non-familial/hereditary)disease characterized in the majority of the cases by hereditary or acquired impaired cytotoxic T-cell(CTL)and natural killer responses.The molecular mechanisms underlying impaired immune homeostasis have been clarified,particularly for primary diseases.Familial HLH(familial hemophagocytic lymphohistiocytosis type 2-5,Chediak-Higashi syndrome,Griscelli syndrome type 2,Hermansky-Pudlak syndrome type 2)develops due to a defect in lytic granule exocytosis,impairment of(signaling lymphocytic activation molecule)-associated protein,which plays a key role in CTL activity[e.g.,X-linked lymphoproliferative syndrome(XLP)1],or impairment of X-linked inhibitor of apoptosis,a potent regulator of lymphocyte homeostasis(e.g.,XLP2).The development of primary HLH is often triggered by infections,but not in all.Secondary HLH develops in association with infection,autoimmune diseases/rheumatological conditions and malignancy.The molecular mechanisms involved in secondary HLH cases remain unknown and the pathophysiology is not the same as primary HLH.For either primary or secondary HLH cases,immunosuppressive therapy should be given to control the hypercytokinemia with steroids,cyclosporine A,or intravenous immune globulin,and if primary HLH is diagnosed,immunochemotherapy with a regimen containing etoposide or anti-thymocyte globulin should be started.Thereafter,allogeneic hematopoietic stem-cell transplantation is recommended for primary HLH or secondary refractory disease(especially EBVHLH).