Treatment of HLH and the Use of Anakinra

The preferred treatment for HLH is dexamethasone due to its ability to penetrate well. The recommended starting dose for dexamethasone is about 10 mg per meter squared body surface or 15 to 20 milligrams daily. Some patients, especially those with rheumatologic diseases, may require higher doses of steroids. In some cases, a pulse dose of methylprednisolone may be considered, but caution is advised due to potential complications. Anakinra, an IL-1 receptor inhibitor, has shown potential benefits in HLH, especially in sicker patients. However, it may require high doses, which could be challenging to obtain in many centers.