Reactive hemophagocytic syndrome in adults: a retrospective analysis of 162 patients

Am J Med. 2014 Nov;127(11):1118-1125. doi: 10.1016/j.amjmed.2014.04.034. Epub 2014 May 14.


Objectives: Current knowledge in reactive hemophagocytic syndrome mainly relies on single-center case series including a relatively small number of patients. We aimed to identify a multicenter large cohort of adult patients with reactive hemophagocytic syndrome and to describe relevant clinical and laboratory features, underlying conditions, and outcome.

Methods: We conducted a multicenter study in 3 tertiary care centers in France over a 6-year period. The medical files of 312 patients with suspected hemophagocytic syndrome were retrospectively reviewed. Patients were classified with a positive, negative, or undetermined diagnosis of hemophagocytic syndrome by experts' consensus.

Results: Among the 312 patients fulfilling our inclusion criteria, 162 were classified with positive hemophagocytic syndrome (male, 67%; median age, 48 [35-62] years). Compared with patients without hemophagocytic syndrome, patients with hemophagocytic syndrome more frequently had an underlying immunodepression (45% vs 33%, P = .03) and exhibited higher temperature, ferritin, triglycerides, aspartate transaminase, bilirubin, lactate dehydrogenase, and C-reactive protein, and lower hemoglobin, leukocytes, platelets, and sodium levels. Only 70% of them had hemophagocytosis features on bone marrow aspiration. Hematologic malignancies, especially non-Hodgkin lymphomas, were the main trigger of hemophagocytic syndrome, accounting for 56% of cases. The early mortality rate (ie, within 1 month after diagnosis) was 20%. Patients with hematologic malignancies-associated hemophagocytic syndrome had a poorer early outcome than those with underlying infection.

Conclusions: In this large, multicenter study, hematologic malignancies are the main disease associated with hemophagocytic syndrome in adults. Early mortality is high, and outcome is influenced by the underlying disease.

Keywords: Adult; Hemophagocytic lymphohistiocytosis; Hemophagocytic syndrome; Infection; Lymphoma; Outcome.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Phytogenic / therapeutic use
  • Aspartate Aminotransferases / blood
  • Bilirubin / blood
  • C-Reactive Protein / analysis
  • Etoposide / therapeutic use
  • Female
  • Ferritins / blood
  • Fever / epidemiology
  • France / epidemiology
  • Glucocorticoids / therapeutic use
  • Hemoglobins / analysis
  • Humans
  • Immunocompromised Host
  • L-Lactate Dehydrogenase / blood
  • Leukocyte Count
  • Lymphohistiocytosis, Hemophagocytic / drug therapy
  • Lymphohistiocytosis, Hemophagocytic / epidemiology*
  • Lymphoma / epidemiology
  • Male
  • Middle Aged
  • Multiple Organ Failure / epidemiology
  • Platelet Count
  • Retrospective Studies
  • Sodium / blood
  • Triglycerides / blood


  • Antineoplastic Agents, Phytogenic
  • Glucocorticoids
  • Hemoglobins
  • Triglycerides
  • Etoposide
  • C-Reactive Protein
  • Ferritins
  • Sodium
  • L-Lactate Dehydrogenase
  • Aspartate Aminotransferases
  • Bilirubin