TNF and macrophage activation syndrome: Cyclosporine A, a safe, effective, and affordable treatment [82] also included in the AHA 2024 guidelines for refractory KD [1] and frequently used in MAS secondary to rheumatologic diseases [80], was administered in the HLH-2004 protocol for 32 patients; in 18 patients, it was combined with GCs, methotrexate in 1 case, and anti-TNF biologic therapy in 4 patients.