The prevalence and prognosis of hyponatraemia in non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis

Abstract

Background:Non-Hodgkin lymphoma associated hemophagocytic lymphohistiocytosis (NHL-HLH) in adult secondary HLH (sHLH) is a common and universally highly lethal critical disorder. Hyponatraemia is the most common electrolyte disorder in the critical illness setting and acts as a negative prognostic factor.The aim of our study was to evaluate the prognostic role of hyponatraemia among patients with NHL-HLH.Methods: This retrospective study enrolled 153 newly diagnosed adult NHL-HLH patients, which were divided into 2 groups based on serum sodium concentration on admission, a hyponatraemia and a normonatraemia group. Univariate and multivariateCox regression analysis were used to identify the prognostic factors associated with worse survival. The overall survival time of all the patients were compared using log rank tests. Restricted cubic splines were conducted to address the association between serum sodium concentration and the risk of mortality. Results:The results showed that 81 (52.9%) patients had hyponatraemia. After a median follow-up of 47 (range 14-180) days, there were 72 (88.9%) cumulative deaths in hyponatraemia group while 50 (69.4%) in normonatremia group. Univariate Cox regression analysis showed that hyponatraemia group demonstrated unfavourable overall survival (P = 0.002). After adjustment for confounders, multivariate analysis revealed that hyponatraemia was an independent prognostic factor for OS (Hazard ratio[HR]:1.51, 95% confidence interval [CI]: 1.03-2.20; P = 0.033). Restricted cubic spline confirmed a linear and positive association between serum sodium and the risk of mortality.Conclusions: Hyponatraemia is relatively frequent in NHL-HLH. As a readily available biomarker in clinical routine, it was a promising prognostic predictor for NHL-HLH.

The Clinical Significance and Prognostic Role of Whole-Blood Epstein-Barr Virus DNA in Lymphoma-Associated Hemophagocytic Lymphohistiocytosis

“…In the study by Yao et al, which included 104 non-Hodgkin lymphomaassociated HLH, age, IPI, platelet count, and the NK/T lymphoma subtype were independent risk factors for non-Hodgkin lymphoma-associated HLH (23). Other factors, including poor performance status and hyponatremia, were identi ed as negative prognostic factors for lymphoma-associated HLH (4,24). Li et al also found that a higher EBV load was a negative predictor in B-NHL-associated HLH, however, this study was restricted to B-NHL and only included 31 cases (4).…”