• Olha Halyabar, Margaret H Chang, Michelle L Schoettler, Marc A Schwartz, Ezgi H Baris, Leslie A Benson, Catherine M Biggs, Mark Gorman, Leslie Lehmann, Mindy S Lo, Peter A Nigrovic, Craig D Platt, Gregory P Priebe, Jared Rowe, Robert P Sundel, Neeraj K Surana, Katja G Weinacht, Alison Mann, Jenny Chan Yuen, Patricia Meleedy-Rey, Amy Starmer, Taruna Banerjee, Fatma Dedeoglu, Barbara A Degar, Melissa M Hazen, and Lauren A Henderson.
• Division of Immunolgy, Boston Children's Hospital, Boston, MA, USA.
• Pediatr Rheumatol. 2019 Feb 14; 17 (1): 7.

BackgroundHemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) were historically thought to be distinct entities, often managed in isolation. In fact, these conditions are closely related. A collaborative approach, which incorporates expertise from subspecialties that previously treated HLH/MAS independently, is needed. We leveraged quality improvement (QI) techniques in the form of an Evidence-Based Guideline (EBG) to build consensus across disciplines on the diagnosis and treatment of HLH/MAS.MethodsA multidisciplinary work group was convened that met monthly to develop the HLH/MAS EBG. Literature review and expert opinion were used to develop a management strategy for HLH/MAS. The EBG was implemented, and quality metrics were selected to monitor outcomes.ResultsAn HLH/MAS clinical team was formed with representatives from subspecialties involved in the care of patients with HLH/MAS. Broad entry criteria for the HLH/MAS EBG were established and included fever and ferritin ≥500 ng/mL. The rheumatology team was identified as the "gate-keeper," charged with overseeing the diagnostic evaluation recommended in the EBG. First-line medications were recommended based on the acuity of illness and risk of concurrent infection. Quality metrics to be tracked prospectively based on time to initiation of treatment and clinical response were selected.ConclusionHLH/MAS are increasingly considered to be a spectrum of related conditions, and joint management across subspecialties could improve patient outcomes. Our experience in creating a multidisciplinary approach to HLH/MAS management can serve as a model for care at other institutions.

21 keywords...

hide…