EVOLUTION OF TREATMENT OF CHILDREN WITH LANGERHANS CELL HISTIOCYTOSIS

2021 ◽  
Vol 100 (3) ◽  
pp. 107-120
Author(s):  
M. Minkov ◽  
◽  
◽  
Keyword(s):  
Intracellular Signaling ◽  
Langerhans Cell Histiocytosis ◽  
Standard Treatment ◽  
Organs At Risk ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Maintenance Phase ◽  
Langerhans Cell ◽  
Mitogen Activated Protein Kinase ◽  
Wide Range

Langerhans cell histiocytosis (LCH) is a rare myeloid neoplasm caused by mutations in proteins in the intracellular signaling MAPK (mitogen-activated protein kinase) pathways. Its rarity, wide range of clinical manifestations, and varied course made it difficult to conduct clinical trials. The use of different stratification systems made it even more difficult to compare the published results. The review attempts to summarize approaches to treatment of LCH in children since the 1960s. Materials and methods of research: searches for original papers in PubMed were performed using combinations of the keywords Langerhans cell histiocytosis, X histiocytosis, pediatrics, children, treatment, and therapy. Only full articles published in English and German languages were included in the review. Conclusion: a combination of vinblastine and prednisolone as an intensive initial phase (6–12 weeks) followed by a less intensive maintenance phase of 12 months is the standard treatment of disseminated LCH. Mortality in multisystem LCH is caused by damage to the organs at risk (hematopoiesis, liver and spleen) and is especially high (up to 60–70%) if the patient does not respond to standard treatment. In the remaining patients, mortality is almost negligible, with the main problems being the recurrence of the disease and its irreversible effects in 50% of the survivors. Although systemic therapy has clearly improved survival in patients with the most severe disease, its role in sustaining disease control and prevention of irreversible consequences in patients with low-risk disease is less obvious.

scholarly journals Biological and clinical significance of somatic mutations in Langerhans cell histiocytosis and related histiocytic neoplastic disorders

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 559-564 ◽  
Author(s):  
Carl E. Allen ◽  
D. Williams Parsons
Keyword(s):  
Langerhans Cell Histiocytosis ◽  
Somatic Mutations ◽  
Mapk Pathway ◽  
Clinical Manifestations ◽  
Langerhans Cell ◽  
Braf V600e ◽  
Common Mechanism ◽  
Recurrent Mutations ◽  
Wide Range ◽  
Neoplastic Disorders

AbstractLangerhans cell histiocytosis (LCH), juvenile xanthogranuloma (JXG), and Erdheim–Chester disease (ECD) represent histiocytic disorders with a wide range of clinical manifestations. Until recently, mechanisms of pathogenesis have been speculative and debate has focused on classification of these conditions as reactive versus neoplastic. Genomic studies have been challenged by scarce tissue specimens, as well as heterogeneous nature of the lesions with variable infiltration of pathologic histiocytes. Whole-exome sequencing recently revealed a very low frequency of somatic mutations in LCH, JXG, and ECD compared to other neoplastic disorders. However, at least in the cases of LCH and ECD, there is a very high frequency of activating mutations in MAPK pathway genes, most notably BRAF-V600E, as well as MAP2K1, in LCH and NRAS in ECD. In ECD, recurrent mutations in the PI3K pathway gene PIK3CA have also been described. The heterogeneous clinical manifestations of these disorders may therefore be the cumulative result of activation of MAPK mutations (along with modifying signals from other pathways) at distinct stages of myeloid differentiation. Implications of this model include redefinition of LCH, JXG, and ECD as a group of clinically diverse myeloid neoplastic disorders with a common mechanism of pathogenesis. This model supports refocusing therapeutic strategies for these diseases on a personalized approach based on specific mutations and the cell(s) of origin.

scholarly journals Clinical characteristics and outcomes of Langerhans cell histiocytosis at a single institution in Thailand: a 20-year retrospective study

2021 ◽  
Vol 15 (4) ◽  
pp. 171-181
Author(s):  
Ponrachet Kitticharoenjit ◽  
Nucharin Supakul ◽  
Piya Rujkijyanont ◽  
Chanchai Traivaree ◽  
Apichat Photia ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Langerhans Cell Histiocytosis ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Langerhans Cell ◽  
Organ Involvement ◽  
Bone Imaging ◽  
X Ray ◽  
Wide Range ◽  
Conjugated Hyperbilirubinemia

Abstract Background Langerhans cell histiocytosis (LCH) is a rare disease characterized by the various systems involved and clinical manifestations with a wide range of symptoms. Objectives To describe clinical characteristics, imaging, treatment, and outcomes of pediatric LCH at Phramongkutklao Hospital, Bangkok, Thailand. Methods We conducted a 20-year retrospective review of the medical records of patients diagnosed with LCH from birth to 21 years old from January 1, 1997, to December 31, 2016. Results In all, 14 patients with median age of 2.5 years were studied. Six (43%) patients had single-system (SS) LCH. Five patients (63%) with multisystem (MS) LCH (n = 8. 57%) had risk-organ involvement (RO+). All patients had plain X-ray imaging of their skull with 11 (79%) showing abnormal findings. Tc-99m bone imaging and fluorodeoxyglucose F18 (FDG) positron emission tomography (PET)-computed tomography (CT) demonstrated abnormal findings in 8 (89%) and 4 (29%) patients, respectively. The 5-year event-free survival (EFS) for patients with RO+ MS-LCH was less than that for those without risk-organ involvement (RO−) MS-LCH and SS-LCH (20% vs. 100%, P = 0.005). Hematological dysfunction, hypoalbuminemia, and conjugated hyperbilirubinemia may be worse prognostic factors for RO+ MS-LCH. Conclusion FDG-PET-CT might have a greater accuracy to detect LCH disease than conventional plain X-ray and Tc-99m bone imaging. RO+ MS-LCH has been encountered with relapse and poor outcomes. Hematopoietic involvement, hypoalbuminemia, and conjugated hyperbilirubinemia may be worse prognostic factors for RO+ MS-LCH.

scholarly journals “Langerhan Cell Histiocytosis –Review Of Literature”

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Ashutosh Jaysing Thorat ◽  
Pawan Vilasrao Dawane
Keyword(s):  
Langerhans Cell Histiocytosis ◽  
Clinical Manifestations ◽  
Disease Process ◽  
Surgical Excision ◽  
Langerhans Cell ◽  
Treatment Modalities ◽  
Review Of Literature ◽  
Immature Dendritic Cells ◽  
Wide Range ◽  
Criteria For Diagnosis

Background: Langerhans cell histiocytosis is a relatively rare unique disease process characterized by an abnormal proliferation of immature dendritic cells usually affecting children and young adults.Discussion:  Histiocytosis are rare diseases of great biological variability and a wide range of clinical manifestations. The first manifestations of LCH may occur in the oral cavity may vary from a continuous gingival infection or a dental abscess to necrotizing ulcerating defects or a painful jaw swelling.The criteria  for diagnosis of LCH includes identification of the characteristic clinical features histopathological, Immunohistochemical findings. Various treatment modalities has been adopted including wide surgical excision along with radiotherapy,chemotherapy ,isolated radiotherapy and use of alkalizing agents.Keywords- Langerhans cell histiocytosis, Histiocytosis X , Osteolysis of skull

scholarly journals Three decades of progress from surgery to medical therapy for isolated neuroaxis BRAF V600E–positive Langerhans cell histiocytosis management: illustrative case

2021 ◽  
Vol 1 (19) ◽  
Author(s):  
Nallammai Muthiah ◽  
Kamil W. Nowicki ◽  
Jennifer L. Picarsic ◽  
Michael P. D’Angelo ◽  
Daniel F. Marker ◽  
...  
Keyword(s):  
Langerhans Cell Histiocytosis ◽  
Mapk Pathway ◽  
Clinical Manifestations ◽  
Tumor Burden ◽  
Langerhans Cell ◽  
Mitogen Activated Protein Kinase ◽  
Braf V600e ◽  
Illustrative Case ◽  
Surgical Interventions ◽  
Mitogen Activated Protein

BACKGROUND “Langerhans cell histiocytosis” (LCH) is a term that encompasses single-system or multisystem disorders traditionally characterized by a proliferation of clonal CD1a+/CD207+ myeloid-derived histiocytes. In most cases of LCH, mitogen-activated protein kinase (MAPK) pathway somatic mutations lead to near universal upregulation of phosphorylated extracellular signal-regulated kinase expression. The clinical manifestations of LCH are numerous, but bone involvement is common. Intracranial lesions, especially as isolated manifestations, are rare. OBSERVATIONS The authors presented the case of a long-term survivor of exclusive intracranial LCH that manifested with isolated craniofacial bone and intraparenchymal central nervous system recurrences, which were managed with 3 decades of multimodal therapy. The patient was initially diagnosed with LCH at age 2 years, and the authors documented the manifestations of disease and treatment for 36 years. Most of the patient’s treatment course occurred before the discovery of BRAF V600E. Treatments initially consisted of chemotherapy, radiosurgery, and open resections for granulomatous LCH lesions. Into young adulthood, the patient had a minimal disease burden but still required additional radiosurgical procedures and open resections. LESSONS Surgical treatments alleviated the patient’s immediate symptoms and allowed for tumor burden control. However, surgical interventions did not cure the underlying, aggressive disease. In the current era, access to systemic MAPK inhibitor therapy for histiocytic lesions may offer improved outcomes.

Multiple Myeloma or Brucellosis: A Case Report

2020 ◽  
Vol 20 (1) ◽  
pp. 102-105 ◽  
Author(s):  
Hossein A. Rahdar ◽  
Mansoor Kodori ◽  
Mohamad R. Salehi ◽  
Mahsa Doomanlou ◽  
Morteza Karami-Zarandi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Brucella Melitensis ◽  
Severe Disease ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Bone Marrow Aspiration ◽  
Major Health Problem ◽  
Brucella Infection ◽  
Wide Range ◽  
Parental Treatment

Background: Brucellosis, a major health problem in developing countries, is a multisystem infection with a broad spectrum of clinical manifestations. Hematological complications, ranging from an intravascular coagulopathy to mild homeostasis disorders (such as gammopathy), have been reported in brucella infection. These signs and symptoms may lead to misdiagnosis of brucellosis with other hematological diseases. Case: A 65-year-old male whose occupation was shepherding was referred to our hospital as a known case of multiple myeloma with continuous fever, muscle weakness, and night sweating after taking 2 courses of chemotherapy. The laboratory diagnosis of multiple myeloma had been based on the observation of a high percent of plasma cells in the bone marrow aspiration. At follow- up, the result of patient's fever workup, with 2 sets of blood cultures, was positive for Brucella melitensis. Isolated brucella was confirmed as B. melitensis by 16S rRNA sequencing. Brucellosis serologic test was performed by agglutination test and positive results were obtained. The patient was discharged with the cessation of fever and general improvement after the end of the parental treatment phase of brucella bacteremia. Conclusions: Brucella infection may cause a severe disease, mimicking a primary hematological disease, which could complicate the correct diagnosis. In brucellosis cases, due to the wide range of symptoms, in addition to cultivation and serological methods, molecular methods should also be used to prevent inappropriate diagnosis and additional costs.

Pulmonary Langerhans Cell Histiocytosis

2020 ◽  
Vol 41 (02) ◽  
pp. 269-279
Author(s):  
Brian Shaw ◽  
Michael Borchers ◽  
Dani Zander ◽  
Nishant Gupta
Keyword(s):  
Langerhans Cell Histiocytosis ◽  
Treatment Options ◽  
Skin Lesions ◽  
Langerhans Cell ◽  
Mitogen Activated Protein Kinase ◽  
Myeloid Neoplasm ◽  
Cystic Lung ◽  
Pulmonary Langerhans Cell Histiocytosis ◽  
Mitogen Activated Protein ◽  
The Central Nervous System

AbstractPulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease that is strongly associated with exposure to cigarette smoke. Recently, activating pathogenic mutations in the mitogen-activated protein kinase pathway have been described in the dendritic cells in patients with PLCH and have firmly established PLCH to be an inflammatory myeloid neoplasm. Disease course and prognosis in PLCH are highly variable among individual patients, ranging from spontaneous resolution to development of pulmonary hypertension and progression to terminal respiratory failure. A subset of patients with PLCH may have extrapulmonary involvement, typically involving the skeletal system in the form of lytic lesions, skin lesions, or the central nervous system most commonly manifesting in the form of diabetes insipidus. Smoking cessation is the cornerstone of treatment in patients with PLCH and can lead to disease regression or stabilization in a substantial proportion of patients. Further insight into the underlying molecular pathogenesis of PLCH has paved the way for the future development of disease-specific biomarkers and targeted treatment options directed against the central disease-driving mutations.

scholarly journals Deciphering the Contribution of Human Meningothelial Cells to the Inflammatory and Antimicrobial Response at the Meninges

2013 ◽  
Vol 81 (11) ◽  
pp. 4299-4310 ◽  
Author(s):  
Pierre-Joseph Royer ◽  
Andrew J. Rogers ◽  
Karl G. Wooldridge ◽  
Patrick Tighe ◽  
Jafar Mahdavi ◽  
...  
Keyword(s):  
Protein Kinase ◽  
Intracellular Signaling ◽  
Cell Activation ◽  
Mitogen Activated Protein Kinase ◽  
Meningococcal Infection ◽  
Minor Role ◽  
Content Type ◽  
Wide Range ◽  
Mitogen Activated Protein ◽  
High Level

ABSTRACTWe have investigated the response of primary human meningothelial cells toNeisseria meningitidis. Through a transcriptome analysis, we provide a comprehensive examination of the response of meningothelial cells to bacterial infection. A wide range of chemokines are elicited which act to attract and activate the main players of innate and adaptive immunity. We showed that meningothelial cells expressed a high level of Toll-like receptor 4 (TLR4), and, using a gene silencing strategy, we demonstrated the contribution of this pathogen recognition receptor in meningothelial cell activation. Secretion of interleukin-6 (IL-6), CXCL10, and CCL5 was almost exclusively TLR4 dependent and relied on MyD88 and TRIF adaptor cooperation. In contrast, IL-8 induction was independent of the presence of TLR4, MyD88, and TRIF. Transcription factors NF-κB p65, p38 mitogen-activated protein kinase (MAPK), Jun N-terminal protein kinase (JNK1), IRF3, and IRF7 were activated after contact with bacteria. Interestingly, the protein kinase IRAK4 was found to play a minor role in the meningothelial cell response toNeisseriainfection. Our work highlights the role of meningothelial cells in the development of an immune response and inflammation in the central nervous system (CNS) in response to meningococcal infection. It also sheds light on the complexity of intracellular signaling after TLR triggering.

scholarly journals RecurrentNRASmutations in pulmonary Langerhans cell histiocytosis

2016 ◽  
Vol 47 (6) ◽  
pp. 1785-1796 ◽  
Author(s):  
Samia Mourah ◽  
Alexandre How-Kit ◽  
Véronique Meignin ◽  
Dominique Gossot ◽  
Gwenaël Lorillon ◽  
...  
Keyword(s):  
Protein Kinase ◽  
Lung Tissue ◽  
Langerhans Cell Histiocytosis ◽  
Kinase Inhibitor ◽  
Mapk Pathway ◽  
Univariate Analysis ◽  
Langerhans Cell ◽  
Mitogen Activated Protein Kinase ◽  
Normal Lung ◽  
Pulmonary Langerhans Cell Histiocytosis

The mitogen-activated protein kinase (MAPK) pathway is constantly activated in Langerhans cell histiocytosis (LCH). Mutations of the downstream kinasesBRAFandMAP2K1mediate this activation in a subset of LCH lesions. In this study, we attempted to identify other mutations which may explain the MAPK activation in nonmutatedBRAFandMAP2K1LCH lesions.We analysed 26 pulmonary and 37 nonpulmonary LCH lesions for the presence ofBRAF,MAP2K1,NRASandKRASmutations. Grossly normal lung tissue from 10 smoker patients was used as control. Patient spontaneous outcomes were concurrently assessed.BRAFV600Emutations were observed in 50% and 38% of the pulmonary and nonpulmonary LCH lesions, respectively. 40% of pulmonary LCH lesions harbouredNRASQ61K/Rmutations, whereas noNRASmutations were identified in nonpulmonary LCH biopsies or in lung tissue control. In seven out of 11NRASQ61K/R-mutated pulmonary LCH lesions,BRAFV600Emutations were also present. Separately genotyping each CD1a-positive area from the same pulmonary LCH lesion demonstrated that these concurrentBRAFandNRASmutations were carried by different cell clones.NRASQ61K/Rmutations activated both the MAPK and AKT (protein kinase B) pathways. In the univariate analysis, the presence of concurrentBRAFV600EandNRASQ61K/Rmutations was significantly associated with patient outcome.These findings highlight the importance ofNRASgenotyping of pulmonary LCH lesions because the use of BRAF inhibitors in this context may lead to paradoxical disease progression. These patients might benefit from MAPK kinase inhibitor-based treatments.

scholarly journals A Case Report of Pediatric Langerhans Cell Histiocytosis: Current Approach and Diagnostic Challenges for Dermatologist

2020 ◽  
Vol 12 (3) ◽  
pp. 79-86
Author(s):  
Irwan Junawanto ◽  
Khairuddin Djawad ◽  
Sri Rimayani ◽  
Farida Tabri ◽  
Nurelly N. Waspodo ◽  
...  
Keyword(s):  
Langerhans Cell Histiocytosis ◽  
Poor Prognosis ◽  
Clinical Manifestations ◽  
Current Approach ◽  
Myeloproliferative Disorder ◽  
Langerhans Cell ◽  
Histopathologic Examination ◽  
Chemotherapy Treatment ◽  
Cutaneous Manifestations ◽  
Patient Organ

Abstract Langerhans Cell Histiocytosis (LCH) is a chronic and rare myeloproliferative disorder caused by disorders in Lang-erhans cell proliferation in various organs and tissues. LCH has a wide variety of clinical manifestations, making it difficult to diagnose. Cutaneous manifestations are polymorphic in the form of purpura, papule, vesicles and pustules. LCH can involve vital organs such as the liver and lungs as well as the hematopoiesis system that usually gives a poor prognosis. The prognosis is also influenced by the age of patient, organ dysfunction and response to the first 6 weeks of chemotherapy treatment. A 3-year-old girl reported a major complaint of an abscess-like lesion in the region of neck accompanied by an extensive purpura of scalp, neck and inguinal areas accompanied by vulvar erosions. The immunohistochemical and histopathologic examination support LCH and the clinical improvement after intravenous administration of intravenous 3 mg/m2 Vinblastine chemotherapy, 75 mg/m2 etoposide, oral 40 mg/m2 per prednisone. After the 6th cycle of chemotherapy, the patient died.

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