Articles

Permanent Consequences in Langerhans Cell Histiocytosis Single Center Study

Abstract

Introduction: Langerhans cell Histiocytosis (LCH) is a rare disease characterized by clonal prolifera-tion of Histiocytosis in different tissues. Permanent consequences (PC) described among subjects with Langerhans cell histiocytosis (LCH).In this study we report the prevalence of permanent sequel among long – term survivors of LCH in our center. Methods: We had 30 cases of LCH from 1989 – 2001 who came for at least 3 years after diagnosis. In-formation has been collected from their disease history, and on type and date of onset of any PC. The cumulative risks of developing a PC have been calculated from the date of LCH diagnosis using the Kaplan-Meier and non-parametric method. Results: Among 30 patients 53.3% were female, 46.67% male, mean age at diagnosis 56.86%±7.79 months (range 7-156), median 42.5 months. 19 (63.33%) had single system (SS) and 11 (36.66%) mul-tisystem (MS). Mean age at SS 5.97 ±1.03 yr, mean age of MS 7.59±1.05 yr. Mean age at follow up 11.3 ± 0.9 yr, median 11.5 yr, range 4.16-22 yr. Mean duration of follow up 6.57 ± 0.76 yr, median 5 yr, and range 3-18 yr. Nine of 30 cases (30%) had at least 1PC; in SS (26.3 %) and in MS (36.7%). The most frequent PC was diabetes insipidus (DI) 16.7%, in SS 5.26% , in MS 36.36%, the difference is significant P<0.05.Orthopedic abnormalities 10% which was only in SS (15.79 %), growth retardation (GR) 13.34%. Conclusion: The prevalence of PC in our patients is low which could be due to a small sample and on the other hand as most of our patients had single system involvement, the exact prevalence of PC is not clear. Analysis of cumulative risk shows that some types of PC may become manifest many years from diagnosis and long term follow up is necessary for all patients.

Willman C. Busque L, Griffith BB. et al. Langer- hans, cell histiocytosis ( histiocytosis X ), a clonal prolif- erative disease. N Engl j Med 1994; 331: 154–160.

Schuller A: Ueber eigenartige schadelefekte im jugendalter. Fortschr rontgenstr. 1915; 16(23): 12.

Christian HA: Defects in membranous bones, exoph- thalmos and diabetes insipidus, an unusual syndrome of dyspituitarism. Med Clin North Am. 1920; 3: 849.

Letterer E: Aleukamische retlkulase (ein be tag zu den proliferativen erkankungen des retikuloendotheliala- parates). Frank pathol Z. 1924; 30: 377.

Siwe SA: Die rieticuloendotheliose–ein never krank- heitsbild unter den hepatosplenomegalien. Z kinderh 1933; 35: 212.

Lichtenstein L, jaffee HL: Eosinophilic granuloma of bone with report of a case. Am J pathol 1940; 16: 95.

Nicholson HS, Egeler RM, Nesbit ME. The epide- miology of Langerhans cell histiocytosis. In egeler RM, D, Angio GJ, eds. Hematology / Oncology Clinics of North America 12. Philadelphia, W.B.Saunders, 1998; 379–384.

Hamre M, Hedberg J, Buckley J , et al Langerhans cell histiocytosis : an exploratory epidemiologic study of 177 cases .Med ped Oncol 1997; 28: 92-97. Arjmandi Rafsanjani Kh.

Ceci A, De Terlizzi M, Colella R, et al. Langerhans cell Histiocytosis in childhood: Results from the Italian cooperative AIEOP–CNR–HX, 83 Study. med padiatr oncol 1993; 21 : 259–264 .

Gadner H, Heitger A, Grois N, et al. Treatment strat- egy for disseminated Langerhans cell histiocytosis. Med pediatr oncol 1994; 23: 72- 80.

The French Langerhans, cell histiocytosis study group. A multicenter retrospective survey of Langerhans, cell histiocytosis: 348 cases observed between 1983 and 1993. Arch Dis Child 1996; 75: 17 – 24.

Minkov M , Grois N, Heitger A , et al Treatment of multisystem Langerhans cell histiocytosis results of the DAL – HX 83 and DAL – HX90 studies . DAL – HX study group. Klin pediatr 2000; 212: 139-144.

Gadner H. Grois N, Arico M, et al. Arandomized trial of treatment for multisystem Langerhans, cell histio- cytosis. J pediatr 2001; 138: 728 – 734.

Lahey E. Histiocytosis X- An analysis of prognostic factors .J pediatr 1975; 87: 184 – 189.

Kaplan EL, Meier p, Nonparametric estimation for incomplete observations J Am Stat Assoc 1958; 53: 457- 481.

Willis B, Ablin A, Weinberg V, et al. Disease course and late sequelae of Lngerhan,s cell histiocytosis : 25 – year experience at the university of California , San Fran- cisco .J Clin Oncol 1996; 14: 2073 – 2082 .

Nanduri V, Levitt G, Stanhope R, et al. prevalence of late sequelae of multisystem langerhans , cell histiocyto- sis – A single institution study [ abstr ] .Med pediatr On- col 1999; 32: 235.

Riccardo Haupt, MD, Vasanta Nanduri, MRCPCH , Maria Grazia Calevo, PhD, Cecilia Bernstrand , MD, JorgeL.Braier , MD , et al . Permanent consequences in langerhans cell histiocytosis patient.

Dunger DB, Broadbent V , Yeoman E, et al . The frequency and natural history of diabetes inspidus in chil- drens with Langerhans – cell histiocytosis. N Engl J Med 1989; 321: 1157 – 1162.

Broadbent V, pritchard J. Diabetes insipidus associ- ated with Langerhans cell histiocytosis: Is it reversible Med Pediatr Oncol 1997; 28: 289 – 293.

Haupt R, Fears TR, Heise A, et al. Risk of secondary leukemia after treatment with etoposide ( VP-16 ) for Langerhans cell histiocytosis in the Italian and Austrian – German populations . Int J Cancer 1997; 719–13.

Egeler RM, Neglia JP, Arico M, et al, The relation of Langerhans cell histiocytosis to acute leukemia, lym- phomas, and other solid tumors. The LCH – Malignancy Study Group of the Histiocyte Society. Hematol Oncol Clin North Am 1998; 12; 369 – 378.

Streubel, B, Ye, H, Du, MQ, et al. Translocation t(11;18)(q21;q21) is not predictive of response to chemo- therapy with 2CdA in patients with gastric MALT lym- phoma. Oncology 2004; 66:476.

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IssueVol 2, No 3 (2005) QRcode
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Keywords
LCH long – term survivors DI and other problems

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1.
Arjmandi Rafsanjani K, Bahoush G, Vossugh P, Hedayatiasl A, Faranoush M. Permanent Consequences in Langerhans Cell Histiocytosis Single Center Study. Int J Hematol Oncol Stem Cell Res. 1;2(3):18-22.