P041  Alemtuzumab-related haemophagocytic lymphohistiocytosis: negotiating the cytokine storm

Conclusion HLH is an under-recognised complication of alemtuzumab therapy. Severe HLH requires both cytokine storm-directed treatment and identification/treatment of the trigger. Here, HLH was refractory to first line therapy (steroids and IVIG) and required immune modulation. The combination of alemtuzumab -induced immune dysregulation and sepsis were likely triggers, rather than Gadolinium. Supportive regional and national MDT input were required to guide therapy, especially as the patient wished to avoid etoposide (a standard refractory-HLH therapy) to preserve fertility. MDT working enabled early d ischarge with close monitoring in ambulatory care - a preferred outcome in the coronavirus pandemic.Disclosure N.L. Wong: Grants/research support; In the last 5 years NLW has received educational grant to attend meetings from Eli Lilly.N.J. Morley: Grants/research support; In the last 5 years NJM has received speaker fees and educational grants to attend meetings from ROCHE, AMGEN, AbbVie, TAKEDA, Kite Gilead and Janssen.D.J. Paling: Grants/research support; DJP has recieved speaker fees and educational grants to attend meetings from Biogen, Novartis, Genzyme and Teva.R.S. Tattersall: Grants/research support; In the last 5 years RST has received speaker fees and educational grants to attend meetings from UCB, AbbVie, Pfizer and Janssen.
Source: Rheumatology - Category: Rheumatology Source Type: research