Evidence map›Paper›PMID 42350853›Full record

ArticleJournal of hematopathology2026

Bone marrow hemophagocytosis in patients with hematological malignancies and COVID-19 infections: mimicry or secondary HLH?

Hend A Nooh, Rasha M Abdel-Hamid, Mona S Abdellateif, Lobna Refaat, Ahmed Bayoumi, Eman Z Kandeel, Mohamed Samra, Medhat Khafagy, Mona S ElAshry

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Article in Journal of hematopathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

9 authors.

Hend A NoohClinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt.ORCID http://orcid.org/0000-0002-5957-6480
Rasha M Abdel-HamidClinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt. rasha.elgyar@nci.cu.edu.eg.ORCID http://orcid.org/0000-0002-2177-6153
Mona S AbdellateifMedical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt.ORCID http://orcid.org/0000-0002-5510-4435
Lobna RefaatClinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
Ahmed BayoumiPediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.ORCID http://orcid.org/0009-0000-0086-1466
Eman Z KandeelClinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
Mohamed SamraMedical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
Medhat KhafagySurgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
Mona S ElAshryClinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt.ORCID http://orcid.org/0000-0002-4742-2257

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSevere coronavirus disease 2019 (COVID-19) and secondary hemophagocytic lymphohistiocytosis (sHLH) share overlapping pathogenesis, symptoms, and ultimately fatal outcomes unless prompt early interventions are undertaken. The excessive immune response in COVID-19 may increase hemophagocytes in bone marrow aspirate (BMA), which could mimic sHLH. PURPOSE: We aimed to assess hemophagocytic cells in the BM of COVID-19 patients with hematological neoplasms and examine their link to sHLH.

methodsBMAs from 44 living COVID-19-positive patients with hematological neoplasms were examined, focusing on the presence of hemophagocytic cells. Alongside clinical and laboratory data, patients were classified into two groups according to the HLH-2004 diagnostic criteria: those meeting ≥ 4 criteria (n = 23) and those meeting < 4 criteria (n = 21). BMAs from 44 COVID-19-negative patients with similar hematological malignancies were also analyzed for comparison.

resultsHemophagocytic cells were present in 33/44 (75.0%) COVID-19-positive patients and were associated with normal and increased erythropoiesis (p = 0.044). Hemophagocytosis was significantly more frequent in COVID-19-positive than in COVID-19-negative patients (p < 0.001). Meeting ≥ 4 HLH-2004 criteria was significantly more prevalent in newly diagnosed patients than in those during follow-up/relapse (p = 0.004). Significantly higher H-scores were also observed in newly diagnosed patients compared with those in follow-up (p < 0.001). Patients with severe/critical COVID-19 or intensive care unit (ICU) admission had higher H-scores; however, the differences were not statistically significant (p = 0.509 and 0.246, respectively).

conclusionHemophagocytic cells are significantly observed in COVID-19 patients with hematological neoplasms, but are insufficient to support a classic diagnosis of concurrent sHLH. These findings suggest that COVID-19-associated hyperinflammation may contribute to BM hemophagocytosis in this vulnerable population.

Indexed as

Bone MarrowCOVID-19Hematologic NeoplasmsLymphohistiocytosis, HemophagocyticAdultAgedDiagnosis, DifferentialFemaleHumansMaleMiddle AgedPandemicsSARS-CoV-2Bone marrow aspirateCOVID-19Hematological neoplasmsH-scoreMacrophage activationSecondary hemophagocytic lymphohistiocytosis

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PMID42350853

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