高密度脂蛋白胆固醇及其动态变化在淋巴瘤相关噬血细胞性淋巴组织细胞增生症患者中的临床意义

Hemophagocytic lymphohistiocytosis (HLH) is a fatal disorder characterized by uncontrolled inflammation. In adults, lymphoma is the most common underlying cause. The lipid profile is frequently dysregulated in lymphoma-associated HLH (LA-HLH), and the clinical significance remains to be determined.

This study aimed to evaluate the prognostic value of baseline lipid profiles and the dynamic changes in high-density lipoprotein cholesterol (HDL-c) in adult patients with LA-HLH. DESIGN: A multicenter, retrospective cohort study.

We analyzed 277 adult patients with LA-HLH from 27 medical centers (2015-2023). Baseline lipid levels and post-treatment HDL-c levels were measured. The optimal prognostic cutoff was determined using X-tile software. Survival analysis was performed using Kaplan-Meier and Cox regression methods.

Low HDL-c (<1.03 mmol/L) was observed in 93.9% (260/277) patients at diagnosis. A baseline HDL-c <0.48 mmol/L was independently associated with reduced overall survival (OS; hazard ratio, HR = 1.51, 95% confidence interval, CI: 1.10-2.09, p = 0.012) and 60-day survival (HR = 1.66, 95% CI: 1.10-2.49, p = 0.015). The post-treatment/baseline HDL-c ratio was significantly lower in patients with T/NK-cell malignancies than in those with B-cell non-Hodgkin lymphoma. A lower ratio (<1.71) was significantly associated with reduced survival. Patients with both low baseline HDL-c (<0.48 mmol/L) and low ratio (<1.71) constituted a high-risk group with the worst outcomes (60-day survival: 46.7% vs 81.8%, p = 0.004; median OS: 52 days vs not reached, p < 0.001).

HDL-c and its dynamic changes are clinically feasible markers for predicting outcomes in patients with LA-HLH. Good cholesterol levels predict survival in lymphoma-linked severe immune disorders Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition where the immune system becomes dangerously overactive, leading to uncontrolled inflammation. In adults, this is most commonly triggered by lymphoma. We found that 93.9% (260/277) of adult patients with lymphoma-associated HLH (LA-HLH) had very low levels of good cholesterol (HDL-c) at diagnosis. Patients with lower HDL-c had significantly shorter overall survival and lower 60-day survival rates, while bad cholesterol (LDL-c) did not impact survival. After treatment, 81.2% of patients saw their HDL-c levels increase. Those with smaller post-treatment HDL-c increases also had worse survival outcomes. By combining baseline HDL-c levels and the degree of HDL-c recovery after treatment, patients were divided into risk groups: those with both low starting HDL-c and minimal post-treatment increases faced the poorest survival. These findings show that measuring HDL-c levels and tracking their changes during treatment offer a simple, cost-effective way to predict survival in LA-HLH, helping doctors identify high-risk patients early and adjust therapies accordingly.