Evidence map›Paper›PMID 40608124›Full record

ReviewArchives of gynecology and obstetrics2025

Secondary hemophagocytic lymphohistiocytosis associated with adjuvant pembrolizumab therapy in a young patient with triple-negative breast cancer: a case report with literature review.

G L Olmes, M P Nigdelis, B Haj Hamoud, E-F Solomayer, M Bewarder, J T Bittenbring, N Kranzhöfer, L Thurner, Y-J Kim, A Seibold and 1 more

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PubMed Full text at PMC Publisher
In one paragraph

Review in Archives of gynecology and obstetrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

G L OlmesDepartment of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Germany. gregor.olmes@uks.eu.ORCID 0009-0000-9334-4774
M P NigdelisDepartment of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Germany.
B Haj HamoudDepartment of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Germany.
E-F SolomayerDepartment of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Germany.
M BewarderDepartment for Oncology and Hematology, University Hospital Medical School, 66421, Homburg, Germany.
J T BittenbringDepartment for Oncology and Hematology, University Hospital Medical School, 66421, Homburg, Germany.
N KranzhöferDepartment for Oncology and Hematology, University Hospital Medical School, 66421, Homburg, Germany.
L ThurnerDepartment for Oncology and Hematology, University Hospital Medical School, 66421, Homburg, Germany.
Y-J KimInstitute of General and Special Pathology, University Medical School of Saarland, 66421, Homburg, Saar, Germany.
A SeiboldInstitute of General and Special Pathology, University Medical School of Saarland, 66421, Homburg, Saar, Germany.
M DoerkDepartment of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSecondary hemophagocytic lymphohistiocytosis (HLH) associated with pembrolizumab is a rare immune-related adverse event (irAE). It features a potential life-threatening status including fever and a hyperinflammatory reaction caused by natural killer cells, CD8 + cytotoxic T cells, and antigen-presenting cells leading to multiorgan failure. Secondary HLH is described for immune checkpoint inhibitor (ICI) therapy. Most descriptions refer to patients with melanoma or lung cancer. We report about a 32 year-old patient with secondary HLH associated with adjuvant pembrolizumab therapy according to the Keynote-522 protocol. It was successfully treated with prednisolone.

methodsWe performed a literature review in PubMed including the terms "HLH OR hemophagocytic lymphohistiocytosis AND breast cancer". We found four other cases meeting the inclusion criteria (abstract available in English, breast cancer patient, HLH related to ICI therapy).

resultsApart from the case report, the review featured main aspects about the diagnosis (HScore, histopathological assessment), onset of HLH, and medical treatment. The review indicated that secondary ICI induced HLH in breast cancer patients may be associated with complete response according to their tumor burden. Most cases are reported with an onset of secondary HLH within the neoadjuvant treatment phase and were treated analogously to the Keynote-522 protocol. Our case showed an onset almost 1 year after the initiation of pembrolizumab therapy.

conclusionGyneco-oncologist should be aware of secondary HLH during pembrolizumab therapy and should assess patients with persistent fever using the HScore to diagnose secondary HLH early.

Indexed as

Antibodies, Monoclonal, HumanizedAntineoplastic Agents, ImmunologicalImmune Checkpoint InhibitorsLymphohistiocytosis, HemophagocyticTriple Negative Breast NeoplasmsAdultChemotherapy, AdjuvantFemaleHumansPrednisoloneAntibodies, Monoclonal, HumanizedAntineoplastic Agents, ImmunologicalImmune Checkpoint InhibitorspembrolizumabPrednisoloneBreast cancerCheckpoint inhibitorGynecologyHemophagocytic lymphohistiocytosisPembrolizumab

Identifiers

PMID40608124
PMCPMC12589356

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.