Findings from this study suggest that clinicians should be aware of predictive factors at diagnosis, including hemoglobin < 60 g/L and albumin < 25 g/L, and consider treatment response at 8-weeks as a criterion to identify patients with non-malignancy associated secondary HLH who are at high-risk of disease progression and in need of second-line therapy and allogeneic HCT. This evidence concerns the gene ALB and hemophagocytic syndrome.