Abstract
Background. Pulmonary Langerhans cell histiocytosis (pLCH) is a rare disease, mostly a component of multisystemic LCH. We aimed to investigate the clinical features and treatment results in children with pLCH.
Methods. We retrospectively reviewed the clinical, radiological, and treatment data of 37 patients with pLCH, diagnosed from 1974 to 2022.
Results. 10% (n=37) of 367 patients with LCH had lung involvement. The median age was 1.8 years (range: 0.4 & 17.7) with a male-to-female ratio of 2.3. At admission 29.7% (n=11) presented with respiratory symptoms. Imaging showed a spectrum from nodular opacities to multiple cysts. All but one patient had multisystem disease. Twenty-nine received vinblastine-containing therapy. Ten-year event-free (EFS) and overall survival (OS) rates were 47.8% and 63.3%, respectively. In children younger and older than two years of age, the 10-year EFS was 53.3% vs. 40.2% and the 10-year OS was 58.7% vs. 68.8%, respectively. In children with and without risk organ involvement, 10-year EFS was 51.9% vs. 46.3% and 10-year OS was 51.9% vs. 73.7%.
Conclusions. Lung and multisystem involvement are significant concerns in LCH, highlighting the need for careful management to reduce morbidity and mortality.
Keywords: Langerhans cell histiocytosis, children, pulmonary involvement
Copyright and license
Copyright © 2024 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
How to cite
References
- Wang D, Cui L, Li ZG, et al. Clinical research of pulmonary Langerhans cell histiocytosis in children. Chin Med J (Engl) 2018; 131: 1793-1798. https://doi.org/10.4103/0366-6999.237400
- Barclay M, Devaney R, Bhatt JM. Paediatric pulmonary Langerhans cell histiocytosis. Breathe (Sheff) 2020; 16: 200003. https://doi.org/10.1183/20734735.0003-2020
- Ronceray L, Pötschger U, Janka G, Gadner H, Minkov M; German Society for Pediatric Hematology and Oncology, Langerhans Cell Histiocytosis Study Group. Pulmonary involvement in pediatric-onset multisystem Langerhans cell histiocytosis: effect on course and outcome. J Pediatr 2012; 161: 129-133. https://doi.org/10.1016/j.jpeds.2011.12.035
- Della Valle V, Donadieu J, Sileo C, et al. Chest computed tomography findings for a cohort of children with pulmonary Langerhans cell histiocytosis. Pediatr Blood Cancer 2020; 67: e28496. https://doi.org/10.1002/pbc.28496
- Bano S, Chaudhary V, Narula MK, et al. Pulmonary Langerhans cell histiocytosis in children: a spectrum of radiologic findings. Eur J Radiol 2014; 83: 47-56. https://doi.org/10.1016/j.ejrad.2013.04.044
- Phan M, Birkemeier KL, Crisp M, Santiago J, McGregor NW. Evolution and regression of imaging findings in treated pulmonary Langerhans cell histiocytosis. Proc (Bayl Univ Med Cent) 2020; 34: 156-158. https://doi.org/10.1080/08998280.2020.1823790
- Kamath S, Arkader A, Jubran RF. Outcomes of children younger than 24 months with langerhans cell histiocytosis and bone involvement: a report from a single institution. J Pediatr Orthop 2014; 34: 825-830. https://doi.org/10.1097/BPO.0000000000000218
- Jezierska M, Stefanowicz J, Romanowicz G, Kosiak W, Lange M. Langerhans cell histiocytosis in children - a disease with many faces. Recent advances in pathogenesis, diagnostic examinations and treatment. Postepy Dermatol Alergol 2018; 35: 6-17. https://doi.org/10.5114/pdia.2017.67095
- Tillotson CV, Anjum F, Patel BC. Langerhans cell histiocytosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430885/
- Baig N, Raza MR, Zia N, Maqsood S, Yaqoob N, Ashraf MS. Childhood Langerhans cell histiocytosis: a ten-year study from Pakistan. Pediatric Hematology Oncology Journal 2022; 7: 177-181. https://doi.org/10.1016/j.phoj.2022.10.001
- Le Louet S, Barkaoui MA, Miron J, et al. Childhood Langerhans cell histiocytosis with severe lung involvement: a nationwide cohort study. Orphanet J Rare Dis 2020; 15: 241. https://doi.org/10.1186/s13023-020-01495-5
- Eckstein OS, Nuchtern JG, Mallory GB, et al. Management of severe pulmonary Langerhans cell histiocytosis in children. Pediatr Pulmonol 2020; 55: 2074-2081. https://doi.org/10.1002/ppul.24822
- Odame I, Li P, Lau L, et al. Pulmonary Langerhans cell histiocytosis: a variable disease in childhood. Pediatr Blood Cancer 2006; 47: 889-893. https://doi.org/10.1002/pbc.20676
- Halder R, Anantharaman MB, Seth T, Mahapatra M, Saxena R. Pulmonary Langerhans cell histiocytosis: a not so benign lesion. J Pediatr Hematol Oncol 2019; 41: e122-e124. https://doi.org/10.1097/MPH.0000000000001371
- Radzikowska E. Update on pulmonary Langerhans cell histiocytosis. Front Med (Lausanne) 2021; 7: 582581. https://doi.org/10.3389/fmed.2020.582581
- Li CW, Li MH, Li JX, Tao RJ, Xu JF, Cao WJ. Pulmonary Langerhans cell histiocytosis: analysis of 14 patients and literature review. J Thorac Dis 2016; 8: 1283-1289. https://doi.org/10.21037/jtd.2016.04.64
- Elia D, Torre O, Cassandro R, Caminati A, Harari S. Pulmonary Langerhans cell histiocytosis: a comprehensive analysis of 40 patients and literature review. Eur J Intern Med 2015; 26: 351-356. https://doi.org/10.1016/j.ejim.2015.04.001
- Braier J, Latella A, Balancini B, et al. Outcome in children with pulmonary Langerhans cell histiocytosis. Pediatr Blood Cancer 2004; 43: 765-769. https://doi.org/10.1002/pbc.20112
- Varkki S, Tergestina M, Bhonsle VS, Moses PD, Mathai J, Korula S. Isolated pulmonary Langerhans cell histiocytosis. Indian J Pediatr 2013; 80: 700-703. https://doi.org/10.1007/s12098-012-0866-x
- Aydoğdu K, Günay E, Fındık G, et al. Pulmonary Langerhans cell histiocytosis; characteristics of 11 cases. Tuberk Toraks 2013; 61: 333-341. https://doi.org/10.5578/tt.5944
- Baqir M, Vassallo R, Maldonado F, Yi ES, Ryu JH. Utility of bronchoscopy in pulmonary Langerhans cell histiocytosis. J Bronchology Interv Pulmonol 2013; 20: 309-312. https://doi.org/10.1097/LBR.0000000000000021
- Türk M, Türktaş H, Akyürek N. A Case of Langerhans cell histiocytosis with atypical radiological presentation. Turk Thorac J 2015; 16: 154-156. https://doi.org/10.5152/ttd.2014.4110
- Sharma S, Dey P. Childhood pulmonary Langerhans cell histiocytosis in bronchoalveolar lavage: a case report along with review of literature. Diagn Cytopathol 2016; 44: 1102-1106. https://doi.org/10.1002/dc.23561
- Harari S, Torre O, Cassandro R, Taveira-DaSilva AM, Moss J. Bronchoscopic diagnosis of Langerhans cell histiocytosis and lymphangioleiomyomatosis. Respir Med 2012; 106: 1286-1292. https://doi.org/10.1016/j.rmed.2012.06.012
- Simko SJ, Tran HD, Jones J, et al. Clofarabine salvage therapy in refractory multifocal histiocytic disorders, including Langerhans cell histiocytosis, juvenile xanthogranuloma and Rosai-Dorfman disease. Pediatr Blood Cancer 2014; 61: 479-487. https://doi.org/10.1002/pbc.24772
- Prakash A, Durugappa T, Ramachandran P, Lahitta AV. Pleurodesis in pulmonary langerhans cell histiocytosis in children: a life-saving measure. Indian J Med Paediatr Oncol 2019; 40: 160-162. https://doi.org/10.4103/ijmpo.ijmpo_250_17
- Soyer T, Özyüksel G, Türer ÖB, et al. Bilateral pulmonary Langerhans’s cell histiocytosis is surgical challenge in children: a case report. European J Pediatr Surg Rep 2019; 7: e8-e11. https://doi.org/10.1055/s-0039-1688771
- Verma S, Jondhale S, Bansal D, Radotra BD, Singhi SC. Iodopovidone pleurodesis for isolated pulmonary Langerhan’s cell histiocytosis in a two year old child. Indian J Pediatr 2014; 81: 715-718. https://doi.org/10.1007/s12098-013-1181-x
- How CH, Hsu HH, Chen JS. Chemical pleurodesis for spontaneous pneumothorax. J Formos Med Assoc 2013; 112: 749-755. https://doi.org/10.1016/j.jfma.2013.10.016
- Krooks J, Minkov M, Weatherall AG. Langerhans cell histiocytosis in children: history, classification, pathobiology, clinical manifestations, and prognosis. J Am Acad Dermatol 2018; 78: 1035-1044. https://doi.org/10.1016/j.jaad.2017.05.059