Reactions 1414 - 11 Aug 2012

SAntineoplastics

Haemophagocytic lymphohistiocytosis in a child:case report

A 3-year, 6-month-old boy with stage 4 neuroblastomadeveloped haemophagocytic lymphohistiocytosis (HLH)while receiving chemotherapy with vincristine,cyclophosphamide, cisplatin and pirarubicin [THP-Adriamycin] [routes not stated].

The boy received allopurinol for prevention of tumourlysis syndrome, and dalteparin sodium for an indication of aprethrombotic state. His chemotherapy regimencomprised vincristine 1.5 mg/m2 and cyclophosphamide1200 mg/m2 for 1 day on day 1, cisplatin 18 mg/m2 for5 days on days 1 to 5, and pirarubicin 25 mg/m2 for 1 dayon day 3. On the second day of chemotherapy, hedeveloped high fever, which was resistant to cefpirome andmicafungin. Pancytopenia ensued, then thrombomodulinwas administered due to a rapid increase in his serum fibrindegradation products level. His clinical course wascomplicated by GI bleeding and respiratory distress as aresult of pulmonary oedema, accompanied by a low plasmaantithrombin III level due to coagulopathy. He hadsplenomegaly and increased serum ferritin level, and bonemarrow aspiration showed numerous haemophagocyticfeatures and proliferation of monocytes. A diagnosis ofHLH was made. The boy received methylprednisolone, andhis HLH symptoms resolved within 3 days, apart from hiscytopenia. Prior to his second chemotherapy course, a CTscan showed tumour regression and normalisation oftumour marker levels. Thereafter, his HLH had notrecurred.

Author comment: "Massive tumor cell destructionresulting from the rapid effect of chemotherapy wassupposed to be the cause of HLH in this case."Kounami S, et al. Early-onset hemophagocytic lymphohistiocytosis after the startof chemotherapy for advanced neuroblastoma. Pediatric Hematology and Oncology29: 99-103, No. 1, Feb 2012 - Japan 803075163

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Reactions 11 Aug 2012 No. 14140114-9954/10/1414-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved