급성 골수세포백혈병에서 유도 항암화학요법 후에 발생한 적혈구포식성 림프조직구증식증 1예
Hemophagocytic Lymphohistiocytosis Occurring after Induction Chemotherapy in Acute Myelocytic Leukemia
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초록
악성 종양과 관련한 HLH의 경우는 드물지만 매우 불량한예후를 보인다. 원인불명의 발열과 혈청 페리틴의 증가, 고중성지방혈증, 저피브리노겐혈증 등의 소견을 보일 경우HLH의 가능성을 의심하고 신속하게 골수 검사와 혈청학적검사를 시행하여 신속한 진단과 치료를 시행하는 것이 중요하겠다.
Abstract
Hemophagocytic lymphohistiocytosis (HLH), associated with acute myelocytic leukemia (AML), is a very rare disease. We here report a case of HLH occurring after induction chemotherapy for AML. AML-associated HLH can be triggered by AML itself, by chemotherapeutic agents, or by infectious complications. Our patient developed a high-grade fever of unknown cause, bilateral pulmonary infiltrates, and shock after successful treatment of AML with induction chemotherapy, and had high serum ferritin, hypertriglyceridemia, hypofibrinogenemia, hemophagocytic histiocytes in bone marrow, low natural killer cell activity, and elevated soluble interleukin-2 receptor levels. A diagnosis of HLH was made. Dexamethasone, cyclosporine, and etoposide were given and allogeneic hematopoietic stem cell transplantation was performed. Careful suspicion of HLH may be warranted if a patient experiences fever of unknown etiology, high ferritin levels, and liver dysfunction during AML treatment.
참고문헌 (10)
- Filipovich AH, "Hemophagocytic lymphohistiocytosis and other hemophagocytic disorders", Immunol Allergy Clin North Am, 28, pp.293~313 (2008)
- Chandrakasan S, "Hemophagocytic lymphohistiocytosis : advances in pathophysiology, diagnosis, and treatment", J Pediatr, 163, pp.1253~1259 (2013)
- Machaczka M, "Malignancy-associated hemophagocytic lymphohistiocytosis in adults : a retrospective population-based analysis from a single center", Leuk Lymphoma, 52, pp.613~619 (2011)
- Falini B, "Peripheral T-cell lymphoma associated with hemophagocytic syndrome", Blood, 75, pp.434~444 (1990)
- Bertozzi AI, "Hemophagocytic syndrome associated with neutropenia after chemotherapy", Arch Pediatr, 9, pp.125~129 (2002)
- Janka GE, "Hemophagocytic syndromes", Blood Rev, 21, pp.245~253 (2007)
- Henter JI, "HLH-2004 : Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis", Pediatr Blood Cancer, 48, pp.124~131 (2007)
- Ahn JS, "Clinical significance of clonality and Epstein-Barr virus infection in adult patients with hemophagocytic lymphohistiocytosis", Am J Hematol, 85, pp.719~722 (2010)
- Delavigne K, "Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy", Haematologica, 99, pp.474~480 (2014)
- Park HS, "Clinical features of adult patients with secondary hemophagocytic lymphohistiocytosis from causes other than lymphoma : an analysis of treatment outcome and prognostic factors", Am J Hematol, 91, pp.897~904 (2012)