Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hematologic disorder characterized by unchecked immune activation and hyperinflammation, resulting in end-organ tissue damage and high mortality rates in untreated patients. Since the first description of this condition in 1939, our understanding of HLH has continued to deepen, with increasing appreciation of the differences and similarities between primary (familial) HLH and secondary (acquired) HLH. While primary HLH presents in the early years of life on the backdrop of inherited genetic mutations affecting cytotoxic immune cell function, secondary HLH more commonly presents in adults and is a heterogenous disorder with various potential triggers ranging from infections to malignancy, autoimmune disease, immunodeficiency, and medications. Yet, they converge in a common pathway of widespread systemic inflammation, which clinically manifests with fevers, organomegaly, cytopenias, laboratory derangements, and rapid development of multiorgan failure. As such, early recognition and intervention is critical to prevent irreversible organ damage and death in both primary and secondary HLH. In this review, we focus our attention on adult secondary HLH and explore the latest updates on the pathophysiology, precipitants, clinical presentation, diagnosis and management of this life-threatening condition. Note that primary HLH is reviewed separately as a companion article in this review series.
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Review Article|
November 25, 2025
Hemophagocytic Lymphohistiocytosis in Adults Available to Purchase
Joanne Ino Hsu,
Joanne Ino Hsu
Dana Farber Cancer Institute, Boston, Massachusetts, United States
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Sarah Nikiforow,
Sarah Nikiforow
Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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Nancy Berliner
Brigham and Women's Hospital, Boston, Massachusetts, United States
* Corresponding Author; email: nberliner@bwh.harvard.edu
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Blood blood.2025031100.
Article history
Submitted:
August 5, 2025
Revision Received:
October 2, 2025
Accepted:
October 15, 2025
Citation
Joanne Ino Hsu, Sarah Nikiforow, Nancy Berliner; Hemophagocytic Lymphohistiocytosis in Adults. Blood 2025; blood.2025031100. doi: https://doi.org/10.1182/blood.2025031100
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