skip to main content

irAE HLH — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

HardOncological EmergenciesirAE HLHSCE Medical Oncology

A patient on immunotherapy for melanoma develops haemophagocytic lymphohistiocytosis (HLH). This presents with high fevers, hepatosplenomegaly, pancytopenia, hyperferritinaemia (>10,000 µg/L), hypertriglyceridaemia and elevated soluble IL-2R. What is the management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Immediate high-dose IV methylprednisolone + consideration of etoposide-based HLH protocol (HLH-2004), ICI permanent discontinuation, ICU admission

ICI-induced HLH/MAS (macrophage activation syndrome) is a rare but potentially fatal irAE characterised by uncontrolled immune activation and cytokine storm. The H-score helps assess probability. Management requires: permanent ICI discontinuation, high-dose IV corticosteroids (dexamethasone 10 mg/m² or methylprednisolone 1 g/day), and in refractory cases, etoposide-based HLH-specific protocols (HLH-2004). ICU admission is often required. Ferritin >10,000 µg/L with the clinical syndrome is highly suggestive. Haematology involvement is essential.

Reference: ESMO 2024 irAE Management; Sadaat et al Blood 2020; HLH-2004 protocol