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Blood, 15 February 2001, Vol. 97, No. 4, pp. 1131-1133

BRIEF REPORT

Hemophagocytic lymphohistiocytosis due to germline mutations in SH2D1A, the X-linked lymphoproliferative disease gene

Maurizio Arico, Shinsaku Imashuku, Rita Clementi, Shigeyoshi Hibi, Tomoko Teramura, Cesare Danesino, Daniel A. Haber, and Kim E. Nichols

From the Department of Pediatrics, IRCCS Policlinico S. Matteo, Pavia, Italy; Children's Research Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; Biologia Generale e Genetica Medica, Università di Pavia, Pavia, Italy; Massachusetts General Hospital Cancer Center, Boston, MA; and Children's Hospital of Philadelphia, Philadelphia, PA.

The hemophagocytic lymphohistiocytoses (HLH) comprise a heterogeneous group of disorders characterized by dysregulated activation of T cells and macrophages. Although some patients with HLH harbor perforin gene mutations, the cause of the remaining cases is not known. The phenotype of HLH bears a strong resemblance to X-linked lymphoproliferative disease (XLP), an Epstein-Barr virus (EBV)-associated immunodeficiency resulting from defects in SH2D1A, a small SH2 domain-containing protein expressed in T lymphocytes and natural killer cells. Here it is shown that 4 of 25 male patients with HLH who were examined harbored germline SH2D1A mutations. Among these 4 patients, only 2 had family histories consistent with XLP. On the basis of these findings, it is suggested that all male patients with EBV-associated hemophagocytosis be screened for mutations in SH2D1A. Patients identified as having XLP should undergo genetic counseling, and be followed long-term for development of lymphoma and hypogammaglobulinemia.

© 2001 by The American Society of Hematology.
 

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