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    Clinical and Laboratory Data of Primary Hemophagocytic Lymphohistiocytosis: A Retrospective Review of the Turkish Histiocyte Study Group
    (Galenos Yayıncılık, 2010) Fışgın, Tunç; Patıroğlu, Türkan; Özdemir, Akif; Celkan, Tiraje; Çalışkan, Ümran; Ertem, Mehmet; Yaralı, Neşe; Erduran, Erol; Vergin, Canan; Canpolat, Cengiz; Duru, Feride; Bay, Ali; Özbek, Namık; Yılmaz Karapınar, Deniz
    Objective: This study analyzes the clinical and laboratory findings of children with primary hemophagocytic lymphohistiocytosis (HLH) followed in various referral centers of Turkey. Materials and Methods: A simple three-page questionnaire prepared by the Turkish Histiocyte Study Group was used for documentation of patient data. Results: Age at diagnosis varied from 0.6 to 78 months (median +/- SD, 16.5 +/- 26.1). Sex distribution was almost equal (F/M= 10/12). The frequencies of parental consanguinity and sibling death in the family history were 100% and 81.1%, respectively. The most common clinical findings were hepatomegaly (100%) and fever (95%). The most common laboratory findings were anemia (100%), hyperferritinemia (100%) and thrombocytopenia (90.9%). Triglyceride and total bilirubin levels in the deceased versus surviving group appear to be high (triglyceride: 394 +/- 183 mg/dl, 289 +/- 7 mg/dl; total bilirubin: 2.7 +/- 6.9 mg/dl, 0.5 +/- 1.2 mg/dl, respectively). Conclusion: We concluded that fever, hepatosplenomegaly, anemia, thrombocytopenia, and hyperferritinemia are the most common clinical and laboratory findings in primary HLH. Increased triglyceride and total bilirubin level at the time of diagnosis might be an indicator of poor prognosis in HLH.
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    Malignancy-associated hemophagocytic lymphohistiocytosis in pediatric cases: a multicenter study from Turkey
    (TURKISH J PEDIATRICS, 2009) Celkan, Tiraje; Berrak, Su; Kazanci, Elif; Ozyurek, Emel; Unal, Sule; Ucar, Canan; Yilmaz, Sebnem
    This study evaluates the clinical and laboratory data of children with secondary hemophagocytic lymphohistiocytosis (sHLH) related to malignancy. Charts of patients who met the diagnostic criteria for sHLH associated with malignancy between January 2000-2006 at six different hospitals in Turkey were reviewed retrospectively. The diagnosis of HLH had been established by bone marrow aspiration in 27 patients, cerebrospinal fluid and bone marrow aspiration in one patient and lung-liver biopsy in another. Twenty-nine children were diagnosed as having sHLH related to malignancy. Twenty cases (18 ALL and 2 AML) with acute leukemia (10 girls/10 boys, median age: 8 years [3-14 years]) were found to have sHLH. Five patients with acute leukemia had HLH at the time of diagnosis (Group 1a), and 15 patients with acute leukemia were diagnosed as having sHLH during therapy (Group 1b), namely reactive sHLH associated with the chemotherapy. Nine patients, including two cases each of rhabdomyosarcoma, neuroblastoma, Hodgkin disease, and non-Hodgkin lymphoma (NHL) and one case with Langerhans cell histiocytosis, were diagnosed as having concomitant hemophagocytosis at the initial evaluation of the tumor (Group 2). Fever, anemia, and hypertriglyceridemia were present in all sHLH cases of all three groups. Hepatomegaly was detected in 60.0%, 73.3%, and 88.8% of the three groups, respectively. Splenomegaly was more frequent in patients of Groups la (60.0%) and 2 (88.8%) than in those of Group 1b, the reactive ones (13.3%). Hypofibrinogenemia was detected in all patients of Group la and Group 2. Low level of fibrinogen was present in 91.6%% of patients in Group 1b. All patients in Group 1b (100%) had neutropenia and thrombocytopenia. Neutropenia was found at rates of 60.0% and 55.5% in Group la and Group 2, respectively. Thrombocytopenia was detected in 80.0% of patients in Group la and 77.7% in Group 2. The overall mortality rate was 34.4% (10 cases) in our series of 29 children with sHLH; 50% of deaths were directly attributable to HLH. Pediatric malignancy-associated HLH patients have been commonly described as case presentations or in a review of the literature. We believe that our cohort, compiling 29 children regarding the association between malignancy and HLH, will be useful for pediatricians who are interested in this still mysterious topic.