Eight patients who presented with HLH as an initial presentation of malignancy were included: subcutaneous panniculitis-like T-cell lymphoma (SpTCL) (n = 3); acute lymphoblastic leukemia (ALL) (n = 2); anaplastic large cell lymphoma (ALCL) (ALK+ n = 2); and systemic EBV + T-cell lymphoma of childhood (EBV T L) (n = 1). Here, ALK is linked to hemophagocytic syndrome.