{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:19:19Z","timestamp":1788185959482,"version":"build-2803163510"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) are life-threatening hyperinflammatory conditions. Primary HLH is caused by genetic mutations associated with defective cytotoxicity, while secondary HLH is triggered by various factors, including infection-associated HLH (IAHS), rheumatic diseases-associated HLH (MAS), or malignancy-associated HLH (M-HLH). We retrospectively reviewed the medical records of patients younger than 20 years of age with physician-diagnosed HLH or MAS between January 2005 and July 2022 in a large medical center in Taiwan. Seven patients were prospectively enrolled since Jan 2019. Clinical and laboratory features, treatments rendered, and outcomes of patients with HLH\/MAS were analyzed. Fifty-two patients with HLH\/MAS were included in this study and classified as follows: 21 (40.4%) with IAHS, 20 (38.5%) with MAS, 5 (9.6%) with M-HLH, 4 (7.7%) with primary HLH, and 2 (3.8%) with unclassified HLH (U-HLH). The median age of diagnosis for all patients was 9.04 years, while it ranged between 5.12 (for primary HLH) to 16.03 (for M-HLH) years. Two-year probabilities of survival of each group of HLH\/MAS were 100%, 85.7%, 65.63%, 25%, and 20% for patients with U-HLH, IAHS, MAS, primary HLH, and M-HLH, respectively (log-rank, P =0.0018). The five-year probability of survival was 65.63% for patients with MAS. M-HLH and ICU admission were significantly associated with mortality. Infections and rheumatic diseases are the main triggers or conditions associated with pediatric HLH\/MAS, whereas malignancy is an important etiology among adolescents.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1596113","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T11:42:05Z","timestamp":1752061325000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Etiologies and long-term outcome of pediatric hemophagocytic lymphohistiocytosis and macrophage activation syndrome in Taiwan: a single-center retrospective 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