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2015 ; 12 Suppl 1
(ä): 48
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Screening assays for primary haemophagocytic lymphohistiocytosis in children
presenting with suspected macrophage activation syndrome
#MMPMID26572973
Cruikshank M
; Anoop P
; Nikolajeva O
; Rao A
; Rao K
; Gilmour K
; Eleftheriou D
; Brogan PA
Pediatr Rheumatol Online J
2015[Nov]; 12 Suppl 1
(ä): 48
PMID26572973
show ga
BACKGROUND: Primary haemophagocytic lymphohistiocytosis (HLH) screening assays
are increasingly being performed in patients presenting with macrophage
activation syndrome (MAS). The objective of this study was to describe their
diagnostic and prognostic relevance in children who had presented to paediatric
rheumatology and had undergone investigative work up for MAS. METHODS: Data was
obtained retrospectively from an existing protein screening assay database and
patient records. Assays included: intracellular expression of perforin in CD56+
Natural Killer (NK) cells; CD107a Granule Release Assay (GRA) in response to PHA
in NK cells, or anti-CD3 stimulation of CD8 lymphocytes; in males Signal
Lymphocyte Activating Molecule Associated Protein (SAP), and X-linked Inhibitor
of Apoptosis Protein (XIAP) expression. All assays, requested by paediatric
rheumatology, of children who had undergone investigative work up for MAS over a
5-year period (2007-2011) were included. RESULTS: Twenty-one patients (15
female), median age 6.5 years (range 0.6-16) with follow-up of 16 months (range
1-51), were retrospectively identified. At presentation, 3/21 (14 %) fulfilled
HLH-2004 diagnostic criteria. At least one screening test result was available
for all 21 patients; 7/21 (33 %) had at least one persistent screening test
abnormality. Of this group 4/7 (57 %) died or required haematopoietic stem cell
transplantation (HSCT), compared to 1/14 (7 %) with no screening test abnormality
(p?=?0.025). 3/21 (14 %) ultimately had a diagnosis of primary HLH (two confirmed
genetically; XIAP, familial HLH type 3, and one confirmed clinically). Of the six
patients with abnormal GRA 5/6 had negative routine genetic results. CONCLUSIONS:
Screening for primary HLH is warranted for children whose first rheumatological
presentation is with MAS, since overall 14 % had an eventual diagnosis of primary
HLH. A persistently abnormal GRA in patients presenting with MAS defines a
high-risk group with poor outcome (mortality or HSCT), possibly due to as yet
unidentified genetic cause.