Rescue of HLH with T and B Lymphocyte Involvement Due to Epstein-Barr Virus by PD-1 Inhibitor/Ruxolitinib and Rituximab Combination Regimens: A Case Report

Iran J Immunol. 2023 Dec 31;20(4):466-472. doi: 10.22034/iji.2023.99254.2629. Epub 2023 Oct 24.

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a fatal clinical syndrome. The most common cause of secondary HLH is Epstein-Barr virus (EBV) infection. EBV-HLH is a common clinical disease with high mortality, easy relapse, and poor prognosis. Therefore, treating EBV-HLH with T and B lymphocyte involvement is challenging, and selecting an appropriate treatment regimen is critical. Moreover, research on how to evaluate the recurrence index after remission is scarce. In this study, we reported a case of EBV-HLH successfully treated with programmed cell death protein-1 (PD-1) inhibitor in combination with rituximab. The regimen had a good curative effect, and we successfully detected the trend of early recurrence. Our findings indicated that PD-1 inhibitor in combination with rituximab may help to treat EBV-HLH and maintain EBV-infected T and B whole-line lymphocytes.

Keywords: CD20 Monoclonal Antibody; Epstein-Barr virus; Hemophagocytic Lymphohistiocytosis; Programmed Cell Death Protein-1; Salvage Therapy.

Publication types

  • Case Reports

MeSH terms

  • B-Lymphocytes
  • Chronic Disease
  • Epstein-Barr Virus Infections* / complications
  • Epstein-Barr Virus Infections* / drug therapy
  • Herpesvirus 4, Human
  • Humans
  • Immune Checkpoint Inhibitors / therapeutic use
  • Lymphohistiocytosis, Hemophagocytic* / complications
  • Lymphohistiocytosis, Hemophagocytic* / diagnosis
  • Lymphohistiocytosis, Hemophagocytic* / drug therapy
  • Rituximab / therapeutic use

Substances

  • ruxolitinib
  • Rituximab
  • Immune Checkpoint Inhibitors