Unique presentation of T-cell/histiocyte-rich large B cell lymphoma complicated with hemophagocytic lymphohistiocytosis: case report and review of the literature
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory disorder characterized by dysfunction of NK cells and cytotoxic lymphocytes. We present a rare case of a patient diagnosed with HLH who presented with persistent fever during treatment for refractory T-cell/histiocyte-rich large B-cell lymphoma (TCHRBCL), highlighting the challenges of managing HLH in the context of refractory lymphoma. According to our review of the literature, this is the first case of HLH that developed several months into treatment for refractory TCHRBCL and not in close temporal relation to lymphoma diagnosis.
References
2) Usmani GN, Woda BA, Newburger PE. Advances in understanding the pathogenesis of HLH. Br J Haematol. 2013 Jun;161(5):609-622. doi: 10.1111/bjh.12293. Epub 2013 Apr 12. PMID: 23577835.
3) Esteban YM, de Jong JLO, Tesher MS. An Overview of Hemophagocytic Lymphohistiocytosis. Pediatr Ann. 2017 Aug 1;46(8):e309-e313. doi: 10.3928/19382359-20170717-01. PMID: 28806468.
4) Bichon A, Bourenne J, Allardet-Servent J, Papazian L, Hraiech S, Guervilly C, et al. High Mortality of HLH in ICU Regardless Etiology or Treatment. Front Med (Lausanne). 2021 Oct 6;8:735796. doi: 10.3389/fmed.2021.735796. PMID: 34692727; PMCID: PMC8526960.
5) Jordan MB, Allen CE, Weitzman S, Filipovich AH, McClain KL. How I treat hemophagocytic lymphohistiocytosis. Blood. 2011 Oct 13;118(15):4041-52. doi: 10.1182/blood-2011-03-278127. Epub 2011 Aug 9. PMID: 21828139; PMCID: PMC3204727.
6) Chang TY, Jaffray J, Woda B, Newburger PE, Usmani GN. Hemophagocytic lymphohistiocytosis with MUNC13-4 gene mutation or reduced natural killer cell function prior to onset of childhood leukemia. Pediatr Blood Cancer. 2011 May;56(5):856-8. doi: 10.1002/pbc.22846. Epub 2010 Dec 15. PMID: 21370424; PMCID: PMC3059114.
7) Sukswai N, Lyapichev K, Khoury JD, Medeiros LJ. Diffuse large B-cell lymphoma variants: an update. Pathology. 2020 Jan;52(1):53-67. doi: 10.1016/j.pathol.2019.08.013. Epub 2019 Nov 15. PMID: 31735345.
8) Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007 Feb;48(2):124-31. doi: 10.1002/pbc.21039. PMID: 16937360.
9) Voskoboinik I, Smyth MJ, Trapani JA. Perforin-mediated target-cell death and immune homeostasis. Nat Rev Immunol. 2006 Dec;6(12):940-52. doi: 10.1038/nri1983. PMID: 17124515.
10) Han AR, Lee HR, Park BB, Hwang IG, Park S, Lee SC, Kim K, Lim HY, Ko YH, Kim SH, Kim WS. Lymphoma-associated hemophagocytic syndrome: clinical features and treatment outcome. Ann Hematol. 2007 Jul;86(7):493-8. doi: 10.1007/s00277-007-0278-6. Epub 2007 Mar 9. PMID: 17347847.
11) Gupta A, Tyrrell P, Valani R, Benseler S, Weitzman S, Abdelhaleem M. The role of the initial bone marrow aspirate in the diagnosis of hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2008 Sep;51(3):402-4. doi: 10.1002/pbc.21564. PMID: 18523990.
12) Goel S, Polski JM, Imran H. Sensitivity and specificity of bone marrow hemophagocytosis in hemophagocytic lymphohistiocytosis. Ann Clin Lab Sci. 2012 Winter;42(1):21-5. PMID: 22371906.
13) Fardet L, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, Coppo P, Hejblum G. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol. 2014 Sep;66(9):2613-20. doi: 10.1002/art.38690. PMID: 24782338.
14) Zhang K, Jordan MB, Marsh RA, Johnson JA, Kissell D, Meller J, Villanueva J, Risma KA, Wei Q, Klein PS, Filipovich AH. Hypomorphic mutations in PRF1, MUNC13-4, and STXBP2 are associated with adult-onset familial HLH. Blood. 2011 Nov 24;118(22):5794-8. doi: 10.1182/blood-2011-07-370148. Epub 2011 Aug 31. PMID: 21881043; PMCID: PMC3228496.
15) Clementi R, Dagna L, Dianzani U, Dupré L, Dianzani I, Ponzoni M, Cometa A, Chiocchetti A, Sabbadini MG, Rugarli C, Ciceri F, Maccario R, Locatelli F, Danesino C, Ferrarini M, Bregni M. Inherited perforin and Fas mutations in a patient with autoimmune lymphoproliferative syndrome and lymphoma. N Engl J Med. 2004 Sep 30;351(14):1419-24. doi: 10.1056/NEJMoa041432. PMID: 15459303.
16) Chang TY, Jaffray J, Woda B, Newburger PE, Usmani GN. Hemophagocytic lymphohistiocytosis with MUNC13-4 gene mutation or reduced natural killer cell function prior to onset of childhood leukemia. Pediatr Blood Cancer. 2011 May;56(5):856-8. doi: 10.1002/pbc.22846. Epub 2010 Dec 15. PMID: 21370424; PMCID: PMC3059114.
17) Reddy RR, Babu BM, Venkateshwaramma B, Hymavathi Ch. Silvery hair syndrome in two cousins: Chediak-Higashi syndrome vs Griscelli syndrome, with rare associations. International Journal of Trichology. 2011 Jul;3(2):107-111. DOI: 10.4103/0974-7753.90825. PMID: 22223973; PMCID: PMC3250006.
18) Yohe S, Thyagarajan B. Review of Clinical Next-Generation Sequencing. Arch Pathol Lab Med. 2017 Nov;141(11):1544-1557. doi: 10.5858/arpa.2016-0501-RA. Epub 2017 Aug 7. PMID: 28782984.
19) Ojo AS, Asemota J, Ojukwu S, Rajeh A, Bot A, Smith CJ, et al. B-cell lymphoma-associated hemophagocytic lymphohistiocytosis: A case report. Oncol Lett. 2022 Jun 7;24(2):246. doi: 10.3892/ol.2022.13365. PMID: 35761945; PMCID: PMC9214690.
20) Mahtat EM, Zine M, Allaoui M, Kerbout M, Messaoudi N, Doghmi K, Mikdame M. Hemophagocytic lymphohistiocytosis complicating a T-cell rich B-cell lymphoma. BMC Hematol. 2016 Nov 24;16:28. doi: 10.1186/s12878-016-0065-5. PMID: 27904750; PMCID: PMC5122011.
21) Devitt K, Cerny J, Switzer B, Ramanathan M, Nath R, Yu H, Woda BA, Chen BJ. Hemophagocytic lymphohistiocytosis secondary to T-cell/histiocyte-rich large B-cell lymphoma. Leuk Res Rep. 2014 Jun 2;3(2):42-5. doi: 10.1016/j.lrr.2014.05.004. PMID: 24955327; PMCID: PMC4062756.
22) Ibrahim U, Garcia G, Saqib A, Hussein S, Dai Q. T Cell Histiocyte Rich Large B Cell Lymphoma Presenting as Hemophagocytic Lymphohistiocytosis: An Uncommon Presentation of a Rare Disease. Case Rep Oncol Med. 2017;2017:6428461. doi: 10.1155/2017/6428461. Epub 2017 Aug 21. PMID: 28912991; PMCID: PMC5585646.
23) Metts JL, Park SI, Briones MA, Keller FG. Hemophagocytic Lymphohistiocytosis Secondary to T Cell/Histiocyte-rich Large B Cell Lymphoma in an Adolescent Male. Pediatr Dev Pathol. 2018 Jan-Feb;21(1):95-99. doi: 10.1177/1093526617699137. Epub 2017 Mar 20. PMID: 29187030.
24) Mehta M, Wang J, McHenry R, Zucker S (2015) T-Cell/Histiocyte-Rich Large B-Cell Lymphoma Masquerading as Autoimmune Hepatitis with Clinical Features of Hemophagocytic Lymphohistiocytosis. J Gastrointest Dig Syst 5:283. doi:10.4172/2161-069X.1000283
25) Mitterer M, Pescosta N, McQuain C, Gebert U, Oberkofler F, Coser P, Knecht H. Epstein-Barr virus related hemophagocytic syndrome in a T-cell rich B-cell lymphoma. Ann Oncol. 1999 Feb;10(2):231-4. doi: 10.1023/a:1008212516595. PMID: 10093694.
26) O. S. Aljitawi and J. M. Boone, “Lymphoma-associated hemophagocytic lymphohistiocytosis,” Blood, vol. 120, no. 5, article 932, 2012.
27) Komisarof J, McGann K, Huston A, Katerji H, Morgan MA. An Atypical Presentation of Hemophagocytic Lymphohistiocytosis (HLH) Secondary to Occult Hodgkin Lymphoma. Case Rep Hematol. 2021 Jul 24;2021:6672257. doi: 10.1155/2021/6672257. PMID: 34341690; PMCID: PMC8325589.
28) El Weshi A, Akhtar S, Mourad WA, Ajarim D, Abdelsalm M, Khafaga Y, Bazarbashi S, Maghfoor I. T-cell/histiocyte-rich B-cell lymphoma: Clinical presentation, management and prognostic factors: report on 61 patients and review of literature. Leuk Lymphoma. 2007 Sep;48(9):1764-73. doi: 10.1080/10428190701559124. PMID: 17786712.
29) Karlsson T. Secondary haemophagocytic lymphohistiocytosis: Experience from the Uppsala University Hospital. Ups J Med Sci. 2015;120(4):257-62. doi: 10.3109/03009734.2015.1064500. Epub 2015 Jul 25. PMID: 26212358; PMCID: PMC4816886.
30) Arca M, Fardet L, Galicier L, Rivière S, Marzac C, Aumont C, Lambotte O, Coppo P. Prognostic factors of early death in a cohort of 162 adult haemophagocytic syndrome: impact of triggering disease and early treatment with etoposide. Br J Haematol. 2015 Jan;168(1):63-8. doi: 10.1111/bjh.13102. Epub 2014 Aug 26. PMID: 25157895
31) Wang H, Xiong L, Tang W, Zhou Y, Li F. A systematic review of malignancy-associated hemophagocytic lymphohistiocytosis that needs more attentions. Oncotarget. 2017 Jul 14;8(35):59977-59985. doi: 10.18632/oncotarget.19230. PMID: 28938698; PMCID: PMC5601794.
32) Lee JC, Logan AC. Diagnosis and Management of Adult Malignancy-Associated Hemophagocytic Lymphohistiocytosis. Cancers (Basel). 2023 Mar 18;15(6):1839. doi: 10.3390/cancers15061839. PMID: 36980725; PMCID: PMC10046521.
33) Zhou L, Liu Y, Wen Z, Yang S, Li M, Zhu Q, Qiu S, Gao Y, Wang H, Yuan Y, Zhang H, Chen C, Zeng W, Guan Z, Pan X. Ruxolitinib combined with doxorubicin, etoposide, and dexamethasone for the treatment of the lymphoma-associated hemophagocytic syndrome. J Cancer Res Clin Oncol. 2020 Nov;146(11):3063-3074. doi: 10.1007/s00432-020-03301-y. Epub 2020 Jul 2. PMID: 32617699.
34) Zhao L, Yang H, Qu WY, Lu YJ, Feng Z. Case report: Ruxolitinib plus dexamethasone as first-line therapy in haemophagocytic lymphohistiocytosis. Front Oncol. 2023 Mar 2;13:1054175. doi: 10.3389/fonc.2023.1054175. PMID: 36959780; PMCID: PMC10029757.
Copyright (c) 2024 Andrej Pešić, Vojin Vuković, Sofija Kozarac, Vladimir Otašević, Tamara Bibić, Biljana Mihaljević, Darko Antić
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.