Myeloma-associated Hemophagocytic Lymphohistiocytosis - A Comprehensive Case Study and a Novel Chemotherapy-free Approach with Anakinra

Overview

Journal EJHaem

Specialty Hematology

Date 2024 Oct 17

PMID 39415906

Authors

Maged Al-Ammari

Danny Hsu

Adam Bryant

Affiliations

Soon will be listed here.

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is an immune response syndrome characterized by excessive inflammation and tissue destruction. A limited number of cases involving HLH patients with concomitant multiple myeloma (MM), leading to significant mortality, have been documented, underscoring the importance of timely diagnosis. We present the case of a 78-year-old previously healthy male admitted to our hospital with a newly diagnosed MM. Subsequently, he was diagnosed with HLH and received treatment with anakinra, intravenous immunoglobulin, and dexamethasone. This case report highlights the unique aspect of being the first documented instance of myeloma-associated HLH treated with anakinra.

References

Venizelosa I, Garipidou V, Perifanis V . Hemophagocytic syndrome associated with multiple myeloma. Leuk Lymphoma. 2002; 43(4):897-9. DOI: 10.1080/10428190290017079. View

Machaczka M, Vaktnas J, Klimkowska M, Nahi H, Hagglund H . Acquired hemophagocytic lymphohistiocytosis associated with multiple myeloma. Med Oncol. 2010; 28(2):539-43. DOI: 10.1007/s12032-010-9484-5. View

Kaito K, Ono M, Kobayashi M, Kawamoto S, Nishiwaki K, Masuoka H . [A case of hemophagocytic syndrome with multiple myeloma]. Rinsho Ketsueki. 1992; 33(8):1095-7. View

Janka G, Lehmberg K . Hemophagocytic lymphohistiocytosis: pathogenesis and treatment. Hematology Am Soc Hematol Educ Program. 2013; 2013:605-11. DOI: 10.1182/asheducation-2013.1.605. View

Henter J, Horne A, Arico M, Egeler R, Filipovich A, Imashuku S . HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2006; 48(2):124-31. DOI: 10.1002/pbc.21039. View

Rajkumar S, Kumar S . Multiple myeloma current treatment algorithms. Blood Cancer J. 2020; 10(9):94. PMC: 7523011. DOI: 10.1038/s41408-020-00359-2. View

Runge E, Kou C, Rendo M, Lynch D, Fenderson J . Lenalidomide-Associated Hemophagocytic Lymphohistiocytosis With Plasma Cell Phagocytosis. Cureus. 2021; 13(4):e14409. PMC: 8110293. DOI: 10.7759/cureus.14409. View

Ostronoff M, Ostronoff F, Coutinho M, Calixto R, Maior A, Sucupira A . Hemophagocytic syndrome after autologous peripheral blood stem cell transplantation for multiple myeloma; successful treatment with high-dose intravenous immunoglobulin. Bone Marrow Transplant. 2006; 37(8):797-8. DOI: 10.1038/sj.bmt.1705329. View

Eloseily E, Weiser P, Crayne C, Haines H, Mannion M, Stoll M . Benefit of Anakinra in Treating Pediatric Secondary Hemophagocytic Lymphohistiocytosis. Arthritis Rheumatol. 2019; 72(2):326-334. DOI: 10.1002/art.41103. View

10.

La Rosee P, Horne A, Hines M, von Bahr Greenwood T, Machowicz R, Berliner N . Recommendations for the management of hemophagocytic lymphohistiocytosis in adults. Blood. 2019; 133(23):2465-2477. DOI: 10.1182/blood.2018894618. View

11.

Hsu C, Bennett J, Lipe B . Hemophagocytic Lymphohistiocytosis in a Patient With Multiple Myeloma. Clin Lymphoma Myeloma Leuk. 2018; 19(1):e29-e32. DOI: 10.1016/j.clml.2018.08.017. View

12.

Bergsten E, Horne A, Arico M, Astigarraga I, Egeler R, Filipovich A . Confirmed efficacy of etoposide and dexamethasone in HLH treatment: long-term results of the cooperative HLH-2004 study. Blood. 2017; 130(25):2728-2738. PMC: 5785801. DOI: 10.1182/blood-2017-06-788349. View

13.

Vick E, Patel K, Prouet P, Martin M . Proliferation through activation: hemophagocytic lymphohistiocytosis in hematologic malignancy. Blood Adv. 2018; 1(12):779-791. PMC: 5728056. DOI: 10.1182/bloodadvances.2017005561. View

14.

Baverez C, Grall M, Gerfaud-Valentin M, De Gail S, Belot A, Perpoint T . Anakinra for the Treatment of Hemophagocytic Lymphohistiocytosis: 21 Cases. J Clin Med. 2022; 11(19). PMC: 9572845. DOI: 10.3390/jcm11195799. View

15.

Naymagon L . Anakinra for the treatment of adult secondary HLH: a retrospective experience. Int J Hematol. 2022; 116(6):947-955. PMC: 9365216. DOI: 10.1007/s12185-022-03430-9. View

16.

Constantinescu C, Petrushev B, Rus I, Stefanescu H, Frasinariu O, Margarit S . Mechanistic Insights in Hemophagocytic Lymphohistiocytosis: Subsequent Acute Hepatic Failure in a Multiple Myeloma Patient Following Therapy with Ixazomib-Lenalidomide-Dexamethasone. J Pers Med. 2022; 12(5). PMC: 9145580. DOI: 10.3390/jpm12050678. View

17.

Jordan M, Allen C, Weitzman S, Filipovich A, McClain K . How I treat hemophagocytic lymphohistiocytosis. Blood. 2011; 118(15):4041-52. PMC: 3204727. DOI: 10.1182/blood-2011-03-278127. View

18.

Mendes F, Sobral K, Culler H, Couto S, Pereira J, Rocha V . Acquired hemophagocytic lymphohistiocytosis as initial manifestation of multiple myeloma: A case report and literature review. Medicine (Baltimore). 2020; 99(39):e22299. PMC: 7523830. DOI: 10.1097/MD.0000000000022299. View

19.

Kumar B, Aleem S, Saleh H, Petts J, Ballas Z . A Personalized Diagnostic and Treatment Approach for Macrophage Activation Syndrome and Secondary Hemophagocytic Lymphohistiocytosis in Adults. J Clin Immunol. 2017; 37(7):638-643. DOI: 10.1007/s10875-017-0439-x. View

20.

Trottestam H, Horne A, Arico M, Egeler R, Filipovich A, Gadner H . Chemoimmunotherapy for hemophagocytic lymphohistiocytosis: long-term results of the HLH-94 treatment protocol. Blood. 2011; 118(17):4577-84. PMC: 3208276. DOI: 10.1182/blood-2011-06-356261. View