Cytokine adsorption therapy in lymphoma-associated hemophagocytic lymphohistiocytosis and allogeneic stem cell transplantation.
Jan-Gerd RademacherGerald WulfMichael J KoziolekMichael ZeisbergManuel WallbachPublished in: Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs (2021)
Lymphoma-associated Hemophagocytic lymphohistiocytosis (HLH) represents a severe complication of disease progression, mediated through cytokine release from the lymphoma cells. Cytokine adsorption may contribute as a supportive treatment to stabilize organ function by reduction of cytokine levels. So far, no experiences of cytokine adsorption and simultaneous stem cell transplantation were published. We report the case of a patient with aggressive lymphoma secondary to chronic lymphocytic leukemia with rapidly progressive HLH (Richter's transformation) upon conditioning chemotherapy prior to allogeneic stem cell transplantation (ASCT). Continuous hemodiafiltration was initiated in the treatment of shock with acute renal failure, lactacidosis and need for high-dose catecholamine therapy, integrating an additional cytokine-adsorbing filter (CytoSorb®) to reduce cytokine levels. This was followed by scheduled allogenic stem cell transplantation. We observed a marked decrease in interleukin-6 plasma levels, associated with a reduced need for vasopressor therapy and organ function stabilization. Hematopoietic engraftment was present at day 14 post-ASCT, leading to disease-free discharge at day 100 post-transplantation. Cytokine adsorption may serve as a safe adjunct to HLH/sepsis treatment during allogeneic stem cell transplantation. Clinical studies are required to make future treatment recommendations.
Keyphrases
- stem cell transplantation
- high dose
- low dose
- diffuse large b cell lymphoma
- randomized controlled trial
- acute kidney injury
- systematic review
- squamous cell carcinoma
- mental health
- chronic lymphocytic leukemia
- liver failure
- bone marrow
- signaling pathway
- mesenchymal stem cells
- oxidative stress
- replacement therapy
- radiation therapy
- cell death
- stem cells
- aqueous solution
- clinical practice