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成人噬血细胞性淋巴组织细胞增生症。

Hemophagocytic lymphohistiocytosis in adults.

机构信息

a Department of Pediatrics, Division of Hematology/Oncology/BMT , Medical College of Wisconsin , Milwaukee , WI , USA.

b Cancer and Blood Disorders Institute , Johns Hopkins All Children's Hospital , St. Petersburg , FL , USA.

出版信息

Leuk Lymphoma. 2019 Jan;60(1):19-28. doi: 10.1080/10428194.2018.1482543. Epub 2018 Jul 3.

Abstract

Hemophagocytic lymphohistiocytosis (HLH), a rare but life-threatening condition characterized by uncontrolled inflammation, is increasingly recognized in adults. The management of adult onset HLH is challenging, in part due to gaps in current state of knowledge on etiology, clinical presentation, diagnosis, and management. HLH secondary to triggers such as infections, autoimmune disorders, and malignancy are more commonly seen in adults although cases of familial form have also been reported. Underlying conditions such as sepsis, or malignancy could pose as major confounders while applying universal diagnostic criteria, and therefore could lead to delay in diagnosis. Despite advent of newer therapeutic agents, outcomes of adults continue to remain poor. Future efforts need to be orchestrated to develop evidence-based tailored therapies to improve outcomes of this under recognized heterogeneous entity.

摘要

噬血细胞性淋巴组织细胞增生症(HLH)是一种罕见但危及生命的疾病,其特征为失控性炎症,在成人中越来越受到认识。成人发病 HLH 的治疗具有挑战性,部分原因是目前对其病因、临床表现、诊断和治疗的认识存在空白。尽管也有家族性病例报道,但由感染、自身免疫性疾病和恶性肿瘤等诱因引起的 HLH 在成人中更为常见。在应用通用诊断标准时,败血症或恶性肿瘤等潜在情况可能构成主要混杂因素,从而导致诊断延迟。尽管出现了新的治疗药物,但成人的预后仍然很差。需要努力制定基于证据的靶向治疗方法,以改善这种认识不足的异质性实体的预后。

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