Abstract Details

Title Successful Reuse of Etoposide after Development of Posterior Reversible Encephalopathy Syndrome in Two Patients with Hemophagocytic Lymphohistiocytosis

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 213

Objective

Background BACKGROUND: HLH is a potentially life-threatening disease caused by overactivation of T-cells and angiten-presenting cells. Standard treatment protocol includes etoposide that rarely causes PRES. Since HLH is a very rare condition, there is no second line treatment recommendation available for patients who developed complications from the standard treatment. Here we report two similar cases that etoposide was successfully reused after development of PRES after the initial treatment.

Design/Methods DESIGN/METHODS: Case 1. A previously healthy 18-year-old male developed fever and multi-organ failure and diagnosed with HLH. After the initiation of treatment with etoposide and dexamethasone, he developed a new onset generalized tonic clonic seizure. Brain MRI confirmed diagnosis of PRES and an follow up brain MRI showed resolution of the lesion. This patient also had significant thrombocytopenia and brain MRI showed stable multiple subcortical microbleeds. Case 2. A 22-year-old female with no significant past medical history developed fever, generalized weakness and multi organ failuare and diagnosed with HLH. After being treated with etoposide and dexamethasone, she developed a new onset generalized tonic clonic seizure and brain MRI showed typical PRES feature. Follow up brain MRI showed complete resolution.

Results RESULTS: In both cases, etoposide was resumed after getting a follow up brain MRI's that showed significant improvement. Both patients have received maintenence treatment with etoposide without neurological complication.

Conclusions CONCLUSIONS: We report two cases of HLH who were successfully treated with reusing etoposide after development of PRES. Etoposide may be safely resumed in patients with HLH who had PRES from previous treatments.

Authors/Disclosures
Yoon J. Choi, MD (University of California, Irvine) PRESENTER	Dr. Choi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SpringWorks.
Kiren Kresa-Reahl, MD (Atara Biotherapeutics)	Dr. Kresa-Reahl has received personal compensation for serving as an employee of Atara Biotherapeutics Inc.. Dr. Kresa-Reahl has received stock or an ownership interest from Atara Biotherapeutics Inc.

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