Familial Hemophagocytic Lymphohistiocytosis Syndrome (fHLH) is a rare, often life-threatening immune disorder caused by genetic mutations that impair immune regulation, leading to severe inflammation and tissue damage. HLH, the broader term, may be inherited or acquired, with secondary HLH—triggered by infections or cancer—being more common. Ongoing research aims to better understand and prevent this serious condition.
Hemophagocytic Lymphohistiocytosis Syndrome can be of two types:
According to research, approximately 75% of patients are diagnosed with secondary HLH, and only 25% are patients with the primary (fHLH). It is equal to 1 in every 50,000 people globally.
Some common symptoms of familial hemophagocytic lymphohistiocytosis syndrome (fHLH) and hemophagocytic lymphohistiocytosis (HLH) are as follows:
Including these, other symptoms of Hemophagocytic Lymphohistiocytosis Syndrome (HLH) include neurological disorders, dizziness, digestive issues, anaemia, jaundice, irritability and headaches.
Familial Hemophagocytic Lymphohistiocytosis (fHLH) is a part of HLH and is caused by genetic predispositions. Mutations in genes such as PRF1 (perforin), UNC13D, STX11, STXBP2, and RAB27A disrupt the function of cytotoxic T-cells and natural killer (NK) cells. Specifically, these mutations impair the pathway these cells use to kill infected or abnormal cells (perforin-mediated cytotoxicity). This failure to kill target cells and terminate an immune response leads to uncontrolled activation of immune cells and a massive, damaging release of inflammatory cytokines.
HLH can sometimes be acquired. The following are some of the causes of Hemophagocytic Lymphohistiocytosis Syndrome (HLH):
The following are some common complications of fHLH and HLH:
Based on the patient's symptoms, the medical professionals conduct a series of tests to diagnose FHLH:
Initial therapy almost always involves high-dose corticosteroids (e.g., Dexamethasone) to rapidly control the systemic inflammation. The following are some of the best treatment methods for HLH:
Except for these treatment processes, doctors use certain medications such as antivirals and antibiotics to reduce the hyperactivity of the immune system. Additionally, blood transfusion and chemotherapy are some of the most effective treatment methods for HLH.
As a genetic disorder, familial HLH cannot be prevented by lifestyle changes. The cornerstone of management is early diagnosis and preparation for curative treatment with hematopoietic stem cell transplant (HSCT). For all forms of HLH, prompt identification and treatment of infections are crucial, as they can trigger severe flares.
Furthermore, early diagnosis and relevant treatment plans, such as stem cell transplants, effectively cure familial haemophagocytic lymphohistiocytosis syndrome. It is the only way to prevent the recurrence of fHLH and HLH. However, if the condition is left untreated, it can turn fatal.