Therapeutic Effect of PE+CRRT Combined with Chemotherapy on Children with Severe EBV-HLH and Non-EBV-HLH

Abstract

To investigate the difference in the therapeutic effect of plasma exchange and continuous renal replacement therapy (PE+CRRT) combined with chemotherapy in the treatment of children with severe Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and non-EBV-HLH. The clinical data of 21 cases of all children with severe HLH treated by PE+CRRT combined with chemotherapy from January 2017 to January 2020 were collected and retrospectively analyzed. According to the presence of EBV infection, the children were divided into EBV+ group and EBV- group. The differences of the observation indexes between the children in the two groups and the improvement of the observation indexes of each group before and after treatment were compared. Among the 21 children, 14 were divided into the EBV+ group and 7 were divided into the EBV- group. There was no difference in age, sex and the number of organ damage between the children in the two groups (P>0.05). Duration of PE+CRRT was longer in the EBV+ group as compared with the EBV- group (P<0.05). Before treatment, the ANC in the EBV+ group was lower than that in the EBV- group (P<0.05), and there was no significant difference in the other observation indexes between the two groups (P>0.05). After treatment, Hb, Fib, APTT, SF, ALT, AST, LDH, Alb, CHE, TBil and TBA of the children in the EBV+ group were significantly improved as compared with those before treatment (P<0.05), but ANC, PLT, TG showed not improve (P>0.05); Fib, APTT, SF, LDH, Alb, and CHE in the EBV- group were significantly as improved compared with those before treatment (P<0.05), while the ANC, PLT, Hb, TG, ALT, AST, TBil, and TBA were not improved (P>0.05). After treatment, the differences of Fib and SF in the children between the EBV+ group and the EBV- group were statistically significant (P<0.05), and there was no significant difference in the other observation indexes of the children between the two groups (P>0.05). Compared with the children before treatment, EBV-DNA in the EBV+ group were decreased significantly in 2-4 weeks after treatment (P<0.05). After PE+CRRT combined with chemotherapy, the overall survival rate of the children with severe HLH was 66.7%, and there was no significant difference in overall survival rate between EBV+ group and EBV- group (P>0.05). PE+CRRT combined with chemotherapy can reduce serum ferritin quickly, then improve organ function, and increase the overall survival rate of severe HLH, and it is a good effect on children with severe EBV-HLH and non-EBV-HLH.