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Background <p>Severe 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.</p> Purpose <p>We aimed to assess hemophagocytic cells in the BM of COVID-19 patients with hematological neoplasms and examine their link to sHLH.</p> Methods <p>BMAs 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 (<i>n</i> = 23) and those meeting &lt; 4 criteria (<i>n</i> = 21). BMAs from 44 COVID-19-negative patients with similar hematological malignancies were also analyzed for comparison.</p> Results <p>Hemophagocytic cells were present in 33/44 (75.0%) COVID-19-positive patients and were associated with normal and increased erythropoiesis (<i>p</i> = 0.044). Hemophagocytosis was significantly more frequent in COVID-19-positive than in COVID-19-negative patients (<i>p</i> &lt; 0.001). Meeting ≥ 4 HLH-2004 criteria was significantly more prevalent in newly diagnosed patients than in those during follow-up/relapse (<i>p</i> = 0.004). Significantly higher H-scores were also observed in newly diagnosed patients compared with those in follow-up (<i>p</i> &lt; 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 (<i>p</i> = 0.509 and 0.246, respectively).</p> Conclusion <p>Hemophagocytic 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.</p>

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

  • 期刊论文

  • 发表日期：

    2026年6月25日

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

摘要

Background

Severe 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.

Methods

BMAs 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.

Results

Hemophagocytic 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).

Conclusion

Hemophagocytic 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.