Hemophagocytic lymphohistiocytosis due to pembrolizumab therapy for adenocarcinoma of the lung

James J Doyle; James A Hall; Kelsey Reely; Jyothi Dodlapati

doi:10.1080/08998280.2021.1945353

Hemophagocytic lymphohistiocytosis due to pembrolizumab therapy for adenocarcinoma of the lung

Proc (Bayl Univ Med Cent). 2021 Jul 14;34(6):729-730. doi: 10.1080/08998280.2021.1945353. eCollection 2021.

Authors

James J Doyle¹, James A Hall², Kelsey Reely¹, Jyothi Dodlapati³

Affiliations

¹ Department of Internal Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas.
² Department of Hematology-Oncology, Baylor Scott and White Medical Center - Temple, Temple, Texas.
³ Department of Hematology-Oncology, Central Texas Veterans Healthcare System, Temple, Texas.

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of dysregulated inflammation. It is most commonly seen in children who have a predisposing genetic mutation. However, adults can contract an acquired version of the disorder secondary to an infectious, neoplastic, or other inflammatory insult. There have been several documented cases of HLH being induced by treatment with immunotherapy. Here, we present the case of a 71-year-old man who was receiving pembrolizumab for lung adenocarcinoma when he developed HLH following his 14th cycle of therapy. Although bone marrow biopsy was negative, he nevertheless fulfilled the diagnostic criteria of the HLH 2004 report and was treated with high-dose steroids followed by a prolonged taper, with resolution of his symptoms and normalization of his blood counts.

Keywords: Hemophagocytic lymphohistiocytosis; immune checkpoint inhibitors; immunotherapy; pembrolizumab.

Publication types

Case Reports