Reactive (or secondary)
hemophagocytic syndrome (RHS) is a potentially lethal condition and characterized by
hypercytokinemia. Immune modulating drugs sometimes fail to achieve satisfactory control. Therefore we investigate the efficacy of continuous
hemodiafiltration using a
polymethyl methacrylate membrane hemofilter (
PMMA-CHDF) for
cytokine removal in patients with RHS. Eight consecutive patients who admitted to our ICU with RHS complicating organ failures and refractory to medical
therapy were initiated
intensive care including
PMMA-CHDF. Although remission was achieved in six patients, remaining two patients died of exacerbation of underlying diseases. Changes in blood levels of
tumor necrosis factor alpha (
TNF-alpha) and
interleukin 6 (IL-6) as indices of
cytokine network activation, and serum
ferritin level as an index of severity of RHS were investigated during
PMMA-CHDF.
PMMA-CHDF performed for 3 days significantly reduced blood
TNF-alpha level (183+/-159 pg/ml to 84+/-98 pg/ml, p<0.05) and also blood
IL-6 level (1113+/-903 pg/ml to 402+/-411 pg/ml, p<0.01). Furthermore, serum
ferritin level was significantly decreased 3 days after initiation of
PMMA-CHDF (52390+/-65168 ng/ml to 4136+/-2932 ng/ml, p<0.05) although it tended to increase before initiation of
PMMA-CHDF. No
PMMA-CHDF-related adverse events were observed in any of the patients.
PMMA-CHDF was effective to remove
cytokine and improved disease severity. Thus,
PMMA-CHDF may be an adjunctive treatment in RHS refractory to medical
therapy.