Significance of Serum Ferritin as a Prognostic Factor for Hemophagocytic Lymphohistiocytosis

Jeung, Sun Ok; Lee, Yun He; You, Eun Sun; Ryu, Kyung Ha

Abstract

PURPOSE: Hemophagocytic lymphohistiocytosis (HLH) rapidly progresses to a fatal outcome, characterized by hemophagocyosis, increased serum ferritin, LDH, triglyceride, and decreased fibinogen. The aim of this study was to evaluate the useful prognostic factors for HLH patients.
METHODS
A retrospective analysis was performed of 11 patients who were diagnosed with HLH at Ewha Womans University Hospital between Jan. 2007 to July 2008.
RESULTS
All patients were treated by HLH-2004 protocol without transplantation. Two of 11 patients died and 1 patient reactivated. Three of 11 patients are off therapy and 5 patients are still getting chemotherapy. There are no significant difference in sex, age, duration of fever, interval from fever onset to chemotherapy, the presence of lymphadenopathy, seizure, rash, infection, serum LDH, SGOT/PT, triglyceride, fibrinogen between survival vs relapse, non-survial group. But the results showed a significant difference in serum ferritin levels at the time of diagnosis (survival vs non-survival, 1,449 vs 15,738; P=0.018, survival vs reactivation, 1,449 vs 3,529; P=0.040) and at day 7 of chemotherapy (survival vs non-survival and reactivation, 526 vs 4,641; P=0.045) between groups.
CONCLUSION
In patients with HLH, serum ferritin levels at diagnosis and at day 7 of chemotherapy is a significant prognostic factor. Therefore, if a patient has fever of unknown origin and pancytopenia, the generalization of blood test for serum ferritin is useful for early diagnosis and better survival rate.