Hemophagocytic Lymphohistiocytosis as a Clinical Harbinger of Rapid Disease Progression in Multiple Myeloma During Daratumumab-Based Therapy
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is rare in patients with multiple myeloma (MM), and its significance during anti-CD38-based therapy remains unclear. We report the case of a 76-year-old man diagnosed with MM and treated with daratumumab, lenalidomide, and dexamethasone who developed HLH before an aggressive clinical relapse. Autopsy revealed diffuse extramedullary plasma cell infiltration, despite the minimal morphological evidence of hemophagocytosis. This case highlights the fact that HLH during immune-modifying therapy should be recognized as a critical clinical harbinger of rapid disease progression in patients with CLL. The early identification of HLH is vital for detecting imminent disease progression and initiating immediate intervention before massive systemic involvement occurs.
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BibTeX
@article{shikata2026hemophagocytic,
title = {{Hemophagocytic Lymphohistiocytosis as a Clinical Harbinger of Rapid Disease Progression in Multiple Myeloma During Daratumumab-Based Therapy}},
author = {Hisaharu Shikata and Masahiko Kaneko and Shoichi Matsukage},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.7688-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7688-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Hemophagocytic Lymphohistiocytosis as a Clinical Harbinger of Rapid Disease Progression in Multiple Myeloma During Daratumumab-Based Therapy
AU - Hisaharu Shikata
AU - Masahiko Kaneko
AU - Shoichi Matsukage
PY - 2026
DA - 2026/08/25
JO - Internal Medicine
DO - 10.2169/internalmedicine.7688-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7688-26/_article
AB - Hemophagocytic lymphohistiocytosis (HLH) is rare in patients with multiple myeloma (MM), and its significance during anti-CD38-based therapy remains unclear. We report the case of a 76-year-old man diagnosed with MM and treated with daratumumab, lenalidomide, and dexamethasone who developed HLH before an aggressive clinical relapse. Autopsy revealed diffuse extramedullary plasma cell infiltration, despite the minimal morphological evidence of hemophagocytosis. This case highlights the fact that HLH during immune-modifying therapy should be recognized as a critical clinical harbinger of rapid disease progression in patients with CLL. The early identification of HLH is vital for detecting imminent disease progression and initiating immediate intervention before massive systemic involvement occurs.
SN - 1349-7235
SN - 0918-2918
ER -