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Dexamethasone palmitate as an etoposide-free treatment for children with hemophagocytic lymphohistiocytosis after hematopoietic cell transplantation

Bone Marrow Transplantation volume 58, pages 1286–1288 (2023)Cite this article

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Post-transplant hemophagocytic lymphohistiocytosis (PT-HLH) is a secondary HLH that can occur after allogeneic hematopoietic cell transplantation (HCT) [1]. A cytokine storm is the major cause of this life-threatening condition. PT-HLH occurs in 0.48% of pediatric transplant recipients within 30 days of HCT [2]. If hyperinflammation cannot be controlled, more than 60% of patients with PT-HLH experience engraftment failure and die of HLH [2]. Various treatments such as corticosteroids, low-dose etoposide (ETP), and immunoglobulins have been tried for PT-HLH; however, no standard treatment has been established [2, 3].

Dexamethasone palmitate (DP) is a drug that contains a combination of dexamethasone and a fat emulsion (lecithin). Compared to dexamethasone, DP is more readily taken up by activated macrophages because of its fat emulsion [4]. Furthermore, it is thought to have a low risk of adverse effects because of its high distribution capacity in inflammatory tissues and low effect on normal lymphocytes.

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Acknowledgements

The authors would like to thank the physicians working at the institutions affiliated with the JCCG who cooperated with this study by submitting the questionnaires. Especially, Nao Yoshida (Japanese Red Cross Nagoya First Hospital), Hiroyuki Ishida (Kyoto City Hospital), Takashi Ishihara (Nara Medical University), Mitsuteru Hiwatari (The University of Tokyo), Nobuyuki Hyakuna (University of Ryukyus), and Shinji Kounami (Wakayama Medical University) contributed in the survey. We also thank Editage (www.editage.com) for English language editing.

Funding

This study was supported by a Grant for Practical Research for Innovative Cancer Control from the Japan Agency for Medical Research and Development (AMED) (21ck0106717h0001) to KS.

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Authors and Affiliations

  1. Department of Pediatrics, St. Luke’s International Hospital, Tokyo, Japan

    Rintaro Ono

  2. Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan

    Kenichi Sakamoto

  3. Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

    Takehiko Doi

  4. Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan

    Ryu Yanagisawa

  5. Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan

    Akira Morimoto

  6. Department of Pediatrics, Showa Inan Hospital, Komagane, Japan

    Akira Morimoto

  7. Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan

    Hirokazu Kanegane

  8. Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan

    Yozo Nakazawa

  9. Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan

    Yoko Shioda

Authors
  1. Rintaro Ono
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  2. Kenichi Sakamoto
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  3. Takehiko Doi
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  4. Ryu Yanagisawa
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  5. Akira Morimoto
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  6. Hirokazu Kanegane
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  7. Yozo Nakazawa
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  8. Yoko Shioda
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Contributions

RO, KS, TD, and AM designed the study, analyzed the data and wrote the manuscript. RY, AM, HK, YN, and YS designed the study and provided advice on analysis and critical review and editing manuscript.

Corresponding author

Correspondence to Kenichi Sakamoto.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by the Clinical Research Review Board of the JCCG and Institutional Review Board of St. Luke’s International Hospital (19–R120). This study was conducted according to the principles of the Declaration of Helsinki.

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Cite this article

Ono, R., Sakamoto, K., Doi, T. et al. Dexamethasone palmitate as an etoposide-free treatment for children with hemophagocytic lymphohistiocytosis after hematopoietic cell transplantation. Bone Marrow Transplant 58, 1286–1288 (2023). https://doi.org/10.1038/s41409-023-02098-x

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  • DOI: https://doi.org/10.1038/s41409-023-02098-x

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