Table 5.

Consensus recommendations for the treatment of refractory/relapsed/intolerant HLH.

S. No.	Recommendation	Grade of evidence	Level of agreement (%)
21.	In GCC patients, genetic predisposition and persistent triggers substantially increase the likelihood of refractory or relapsed HLH, thereby justifying earlier escalation beyond conventional immunochemotherapy.	Low	100% (15/15)
22.	In GCC patients with refractory, relapsed, or treatment-intolerant HLH, risk-adapted management should incorporate targeted and salvage therapy emapalumab, as part of individualized strategies to achieve disease control and facilitate transition (bridge) to definitive therapies such as HSCT.	Moderate	100% (15/15)

Level of agreement was calculated as the proportion of respondents selecting either “agree” or “somewhat agree.”.

GCC, Gulf Cooperation Council; HLH, hemophagocytic lymphohistiocytosis; HSCT, hematopoietic stem cell transplantation.