Macrophage elimination in bone marrow by dexamethasone palmitate is associated with successful engraftment in patients with hemophagocytic syndrome

Excerpt

Nishiwaki et al. described a novel treatment using dexamethasone palmitate (DP) for hemophagocytic syndrome (HPS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) [1]. Because HPS after allo-HSCT frequently progresses to graft failure (GF), aggressive treatments, including corticosteroids, cyclosporine, high-dose immune globulin, and etoposide, have been adopted. However, the efficacy of these conventional treatments for HPS remains unsatisfactory, and moreover, they can result in worsening neutropenia and immune insufficiency. DP is readily taken up by macrophages via phagocytosis and is retained in the cytoplasm. Therefore, DP may be more effective and less toxic for patients with HPS than conventional treatments. Based on Nishiwaki’s study [1], we conducted a retrospective analysis of DP treatment for 16 patients with post-transplant HPS and explored whether surrogate markers can predict the efficacy of DP at preventing GF in patients with HPS after allo-HSCT. All 16 patients studied suffered from HPS before engraftment. Patients suffering from HPS after achieving neutrophil recovery were not included in this study. …