Hemophagocytic lymphohistiocytosis in cutaneous T-cell lymphoma

Dylan E. Lee, M. Estela Martinez-Escala, Linda M. Serrano, Xiaolong A. Zhou, Jason B. Kaplan, Barbara Pro, Jaehyuk Choi, Joan Guitart*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

IMPORTANCE Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. OBJECTIVES To examine the characteristics of CTCL associated with HLH and analyze the presenting signs and symptoms, therapeutic options, and outcome. DESIGN, SETTING, AND PARTICIPANTS In this case series, patients diagnosed with CTCL and HLH who were treated at a single institution from January 1, 2014, through December 31, 2017, were studied. EXPOSURES The HLH-2004 trial criteria, HScore, and various clinical and histopathologic variables were applied to and analyzed in the cohort. MAIN OUTCOMES AND MEASURES Subtype of CTCL, treatment administered for HLH, and patient outcome were assessed. RESULTS Seven patients (4 men and 3 women; median age, 50 years; range, 34-77 years) were identified from the database and included in the study. Cytotoxic subtypes of CTCL that involve the deep dermis and subcutaneous tissue were most commonly associated with HLH. Four patients met 5 or more HLH-2004 trial criteria, and 5 had an HScore probability greater than 85%at presentation. Common presenting HLH symptoms were fever and malaise. Cyclosporine, polychemotherapy, and systemic corticosteroids were the most common treatments. Patients receiving allogeneic stem cell transplants had the best outcomes, with all 3 of these patients alive and in complete remission. CONCLUSIONS AND RELEVANCE Hemophagocytic lymphohistiocytosis is a life-threatening complication of CTCL associated with rare cytotoxic CTCL subtypes that primarily involve the subcutaneous tissue. Because these casesmay resemble a granulomatous or infectious condition, the diagnosis and appropriate management are often delayed. The results of this study demonstrate the need for high awareness of HLH in patients with panniculitic lymphomas and indicate that allogeneic stem cell transplantation may be the best option for a sustained remission.

Original languageEnglish (US)
Pages (from-to)828-831
Number of pages4
JournalJAMA Dermatology
Volume154
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Hemophagocytic Lymphohistiocytosis
Cutaneous T-Cell Lymphoma
Subcutaneous Tissue
Stem Cell Transplantation
Therapeutics
Dermis
Combination Drug Therapy
Cyclosporine
Signs and Symptoms
Lymphoma
Adrenal Cortex Hormones
Fever
Stem Cells
Databases
Guidelines
Transplants

ASJC Scopus subject areas

  • Dermatology

Cite this

Lee, Dylan E. ; Martinez-Escala, M. Estela ; Serrano, Linda M. ; Zhou, Xiaolong A. ; Kaplan, Jason B. ; Pro, Barbara ; Choi, Jaehyuk ; Guitart, Joan. / Hemophagocytic lymphohistiocytosis in cutaneous T-cell lymphoma. In: JAMA Dermatology. 2018 ; Vol. 154, No. 7. pp. 828-831.
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abstract = "IMPORTANCE Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. OBJECTIVES To examine the characteristics of CTCL associated with HLH and analyze the presenting signs and symptoms, therapeutic options, and outcome. DESIGN, SETTING, AND PARTICIPANTS In this case series, patients diagnosed with CTCL and HLH who were treated at a single institution from January 1, 2014, through December 31, 2017, were studied. EXPOSURES The HLH-2004 trial criteria, HScore, and various clinical and histopathologic variables were applied to and analyzed in the cohort. MAIN OUTCOMES AND MEASURES Subtype of CTCL, treatment administered for HLH, and patient outcome were assessed. RESULTS Seven patients (4 men and 3 women; median age, 50 years; range, 34-77 years) were identified from the database and included in the study. Cytotoxic subtypes of CTCL that involve the deep dermis and subcutaneous tissue were most commonly associated with HLH. Four patients met 5 or more HLH-2004 trial criteria, and 5 had an HScore probability greater than 85{\%}at presentation. Common presenting HLH symptoms were fever and malaise. Cyclosporine, polychemotherapy, and systemic corticosteroids were the most common treatments. Patients receiving allogeneic stem cell transplants had the best outcomes, with all 3 of these patients alive and in complete remission. CONCLUSIONS AND RELEVANCE Hemophagocytic lymphohistiocytosis is a life-threatening complication of CTCL associated with rare cytotoxic CTCL subtypes that primarily involve the subcutaneous tissue. Because these casesmay resemble a granulomatous or infectious condition, the diagnosis and appropriate management are often delayed. The results of this study demonstrate the need for high awareness of HLH in patients with panniculitic lymphomas and indicate that allogeneic stem cell transplantation may be the best option for a sustained remission.",
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Hemophagocytic lymphohistiocytosis in cutaneous T-cell lymphoma. / Lee, Dylan E.; Martinez-Escala, M. Estela; Serrano, Linda M.; Zhou, Xiaolong A.; Kaplan, Jason B.; Pro, Barbara; Choi, Jaehyuk; Guitart, Joan.

In: JAMA Dermatology, Vol. 154, No. 7, 01.07.2018, p. 828-831.

Research output: Contribution to journalArticle

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AU - Lee, Dylan E.

AU - Martinez-Escala, M. Estela

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AU - Choi, Jaehyuk

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N2 - IMPORTANCE Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. OBJECTIVES To examine the characteristics of CTCL associated with HLH and analyze the presenting signs and symptoms, therapeutic options, and outcome. DESIGN, SETTING, AND PARTICIPANTS In this case series, patients diagnosed with CTCL and HLH who were treated at a single institution from January 1, 2014, through December 31, 2017, were studied. EXPOSURES The HLH-2004 trial criteria, HScore, and various clinical and histopathologic variables were applied to and analyzed in the cohort. MAIN OUTCOMES AND MEASURES Subtype of CTCL, treatment administered for HLH, and patient outcome were assessed. RESULTS Seven patients (4 men and 3 women; median age, 50 years; range, 34-77 years) were identified from the database and included in the study. Cytotoxic subtypes of CTCL that involve the deep dermis and subcutaneous tissue were most commonly associated with HLH. Four patients met 5 or more HLH-2004 trial criteria, and 5 had an HScore probability greater than 85%at presentation. Common presenting HLH symptoms were fever and malaise. Cyclosporine, polychemotherapy, and systemic corticosteroids were the most common treatments. Patients receiving allogeneic stem cell transplants had the best outcomes, with all 3 of these patients alive and in complete remission. CONCLUSIONS AND RELEVANCE Hemophagocytic lymphohistiocytosis is a life-threatening complication of CTCL associated with rare cytotoxic CTCL subtypes that primarily involve the subcutaneous tissue. Because these casesmay resemble a granulomatous or infectious condition, the diagnosis and appropriate management are often delayed. The results of this study demonstrate the need for high awareness of HLH in patients with panniculitic lymphomas and indicate that allogeneic stem cell transplantation may be the best option for a sustained remission.

AB - IMPORTANCE Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. OBJECTIVES To examine the characteristics of CTCL associated with HLH and analyze the presenting signs and symptoms, therapeutic options, and outcome. DESIGN, SETTING, AND PARTICIPANTS In this case series, patients diagnosed with CTCL and HLH who were treated at a single institution from January 1, 2014, through December 31, 2017, were studied. EXPOSURES The HLH-2004 trial criteria, HScore, and various clinical and histopathologic variables were applied to and analyzed in the cohort. MAIN OUTCOMES AND MEASURES Subtype of CTCL, treatment administered for HLH, and patient outcome were assessed. RESULTS Seven patients (4 men and 3 women; median age, 50 years; range, 34-77 years) were identified from the database and included in the study. Cytotoxic subtypes of CTCL that involve the deep dermis and subcutaneous tissue were most commonly associated with HLH. Four patients met 5 or more HLH-2004 trial criteria, and 5 had an HScore probability greater than 85%at presentation. Common presenting HLH symptoms were fever and malaise. Cyclosporine, polychemotherapy, and systemic corticosteroids were the most common treatments. Patients receiving allogeneic stem cell transplants had the best outcomes, with all 3 of these patients alive and in complete remission. CONCLUSIONS AND RELEVANCE Hemophagocytic lymphohistiocytosis is a life-threatening complication of CTCL associated with rare cytotoxic CTCL subtypes that primarily involve the subcutaneous tissue. Because these casesmay resemble a granulomatous or infectious condition, the diagnosis and appropriate management are often delayed. The results of this study demonstrate the need for high awareness of HLH in patients with panniculitic lymphomas and indicate that allogeneic stem cell transplantation may be the best option for a sustained remission.

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