Dr. Michelle Hermiston, a pediatric hematologist-oncologist, discusses the history and advances in understanding HLH, focusing on mechanisms of hyperinflammation, classification of HLH, and the importance of collaborative care in managing this complex disease.
HLH is characterized by excessive cytokine production leading to hyperinflammation and multi-organ failure.
Recognizing primary and secondary HLH, understanding cytokine influence, and collaborating with experts are essential in managing the disease effectively.
HLH is a complex disease characterized by excessive immune activation and inability to terminate the immune response. Patients with HLH experience hyperinflammation due to unchecked cytokine production, leading to multi-organ failure and severe clinical manifestations like fever, hypotension, and organ failure. Prompt recognition of HLH is vital to prevent adverse outcomes, as delays can result in high mortality rates. The disease is primarily classified into primary (familial) and secondary HLH, with primary HLH linked to genetic mutations affecting immune function.
Role of Cytokines in HLH Pathogenesis
Interferon gamma and cytokines like IL-1, IL-6, and TNF-alpha play a crucial role in initiating and perpetuating HLH. Patients with HLH exhibit excessive cytokine production, leading to a cascade of inflammatory events and immune dysregulation. The cytokines drive hyperinflammation, resulting in clinical features such as fever, capillary leak, bleeding tendencies, and organ failure. Understanding the role of cytokines is essential in diagnosing and managing HLH effectively.
Challenges in Diagnosing and Managing HLH
Diagnosing HLH poses challenges due to its rarity and varied clinical presentations. Consulting experts and utilizing a multidisciplinary approach are crucial for accurate diagnosis and timely intervention. Treatment decisions for HLH, involving immunosuppression, are complex, especially when infections are involved. Collaborating with colleagues and considering the patient's immune response are key in navigating the therapeutic approach for patients with HLH.
Adam Narloch speaks with Dr Michelle Hermiston to discuss the history of HLH and advances in understanding this rare disease. Dr Hermiston is a pediatric hematologist-oncologist, a bone marrow transplant specialist, and the director of the Pediatric Immunotherapy Program at UCSF Benioff Children’s Hospital. Join us as we start our journey into the world of HLH!