J Korean Med Sci.  2008 Jun;23(3):439-444. 10.3346/jkms.2008.23.3.439.

Treatment Outcomes with CHOP Chemotherapy in Adult Patients with Hemophagocytic Lymphohistiocytosis

• Shin HJ
• Chung JS
• Lee JJ
• Sohn SK
• Choi YJ
• Kim YK
• Yang DH
• Kim HJ
• Kim JG
• Joo YD
• Lee WS
• Sohn CH
• Lee EY
• Cho GJ

• KMID: 1786882
• DOI: http://doi.org/10.3346/jkms.2008.23.3.439

Abstract

The objective of the current study was to investigate the treatment outcomes for the use of cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) chemotherapy in adult patients with hemophagocytic lymphohistiocytosis (HLH). Seventeen HLH patients older than 18 yr of age were treated with CHOP chemotherapy. A response evaluation was conducted for every two cycles of chemotherapy. With CHOP chemotherapy, complete response was achieved for 7/17 patients (41.2%), a partial response for 3/17 patients (17.6%), and the overall response rate was 58.8%. The median response duration (RD) was not reached and the 2-yr RD rate was 68.6%, with a median follow-up of 100 weeks. Median overall survival (OS) was 18 weeks (95% CI, 6-30 weeks) and the 2-yr OS rate was 43.9%. Reported grade 3 or 4 non-hematological toxicities were increased serum liver enzyme levels and stomatitis. Grade 3 or 4 hematological toxicities were leukopenia (50.8%), anemia (20%), and thrombocytopenia (33.9%). Neutropenic fever was observed in 21.6% of patients (14/65 cycles), and most of the cases were resolved with supportive care including treatment with broad-spectrum antibiotics. CHOP chemotherapy seems to be effective in adult HLH patients and the toxicities are manageable.

Keyword

Lymphohistiocytosis, Hemophagocytic; Herpesvirus 4, Human; Lymphoma; CHOP Protocol

MeSH Terms

Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols/*administration & dosage/adverse
Cyclophosphamide/administration & dosage/adverse effects
Doxorubicin/administration & dosage/adverse effects
Female
Follow-Up Studies
Humans
L-Lactate Dehydrogenase/blood
Lymphohistiocytosis, Hemophagocytic/*drug therapy
Male
Middle Aged
Prednisone/administration & dosage/adverse effects
Remission Induction
Survival Rate
Treatment Outcome
Vincristine/administration & dosage/adverse effects

Figure

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  Fig. 1 Two-year response duration rate 68.6% (A) and overall survival rate 43.9% (B) for adult patients with hemophagocytic lymphohistiocytosis.

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  Fig. 2 Serial serum LDH level. (A) HLH patients who showed CR after CHOP chemotherapy. (B) HLH patients who showed PR or NR after CHOP chemotherapy.

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