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Late outcomes in children with Langerhans cell histiocytosis
  1. Tin Wai Chow1,
  2. Wing Kwan Leung1,
  3. Frankie Wai Tsoi Cheng1,
  4. Shekhar Medhukar Kumta2,
  5. Winnie Chiu Wing Chu3,
  6. Vincent Lee1,
  7. Matthew Ming Kong Shing1,
  8. Chi Kong Li1
  1. 1 Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
  2. 2 Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, New Territories, Hong Kong
  3. 3 Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, New Territories, Hong Kong
  1. Correspondence to Dr Chi Kong Li, Deparment of Paediatrics, Chinese University of Hong Kong, Hong Kong; ckli{at}cuhk.edu.hk

Abstract

Introduction Langerhans cell histiocytosis (LCH) is a rare disease with diverse clinical courses. Despite improvement in survival outcomes in the recent decades, sequelae of the disease remain a concern. This study aimed to provide information on the long-term outcomes in patients with LCH, particularly on the sequelae and any associated factors.

Method Medical records of patients with diagnosis of LCH and being managed in our centre were retrospectively reviewed. Data on the courses of illness, mortality, intervention, types and time of late events were collected and analysed.

Results 70 patients were included with a mean observation time of 12 years (median 10.7 years, range 1–31.3 years). Sequelae related to LCH were present in 56% (n=39), being more common in multisystem diseases and patients with reactivations. Prevalence of sequelae is as follows: orthopaedic related 27%, diabetes insipidus 19%, growth retardation 13%, cosmetic 10%, neurological 7%, hearing 7%, anterior pituitary hormone deficiency 7%, hepatobiliary 4% and ophthalmological 3%. Neurological sequelae could manifest even 10 years after initial diagnosis of LCH. Reactivations, presence of central nervous system (CNS) risk lesions and treatment with radiotherapy were associated with a higher rate of sequelae. The cumulative incidence of reactivation was 34%. Most reactivations occurred in the first 2.5 years after diagnosis.

Conclusion Sequelae were common after LCH, although some were mild. Neurological sequelae could be particularly severe and debilitating. Vigilant long-term follow-up would be essential for optimising patient outcomes. Further studies on the prevention and treatment of CNS disease of LCH are warranted.

  • Langerhans cell histiocytosis
  • Permanent consequences
  • Sequelae
  • Long-term outcome
  • Children

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Footnotes

  • Contributors The study protocol was designed by TWC, CKL and WKL.

    Data collection was done by TWC, FWTC, VL, MMKS and SMK. Data analysis was completed by TWC, WCWC, WKL and CKL.

    TWC, WKL and CKL prepared the manuscript which was reviewed, revised and approved by all authors.

  • Competing interests None declared.

  • Ethics approval The Joint Chinese University of Hong Kong New Territories East Cluster Clinical Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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