Case Report: Hemophagocytic lymphohistiocytosis in a multiple myeloma patient

Publication date: Available online 5 September 2018Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Caroline M. Hsu, John M. Bennett, Brea LipeAbstractHemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory state characterized by phagocytosis of hematopoietic elements. It may be triggered by infection, malignancy, and autoimmune disorders and often progresses to multiorgan failure and even death.A 59-year-old man presented to our hospital for recurrent fevers in the setting of known IgA multiple myeloma complicated by end-stage renal disease requiring dialysis. Infectious workup was negative, and he was diagnosed with HLH. Attempts to treat first with DVR-PACE, then with DVP-PACE resulted in transient improvement, but each time, HLH returned with count recovery. The patient was ultimately treated with pomalidomide and daratumumab, which resulted in HLH resolution without recurrence. Unfortunately, his multiple myeloma continued to progress, and he died several months later.HLH in the setting of multiple myeloma is quite rare; since the establishment of the HLH-2004 diagnostic guidelines, this is only the fourth case published. Furthermore, our patient was treated with the novel therapeutic drug daratumumab, an anti-CD38 monoclonal antibody. Through CD38, daratumumab also works to decrease natural killer (NK) cell activity. Thus, we hypothesize that by reducing the NK cell activity, daratumumab resulted in treatment of his HLH independent of the impact on his m...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research