Treatment Options for LCH in Children

Treatment of Low-Risk Disease
        Skin Lesions
        Bone Lesions and Other Low-Risk Organ Lesions
Treatment of High-Risk Disease
Treatment Options for Recurrent, Refractory, and Progressive Childhood LCH

Treatment of childhood Langerhans cell histiocytosis (LCH) skin lesions may include the following:

• Watchful waiting.
• Steroids or nitrogen mustard applied to the skin.
• Chemotherapy, such as methotrexate or thalidomide, given by mouth.
• Photodynamic therapy with psoralen and ultraviolet A radiation (PUVA).

Treatment of childhood LCH bone lesions in the front, sides, or back of the skull, or in any other single bone may include the following:

• Surgery (curettage) with or without steroid therapy.
• Radiation therapy.

Treatment of childhood LCH lesions in bones around the ears or eyes may lower the risk of diabetes insipidus and other long-term problems. Treatment may include:

• Chemotherapy and steroid therapy.
• Surgery (curettage).

Treatment of spine or hip bone lesions that have weakened the bone and may lead to a broken bone in childhood LCH may include:

• Radiation therapy.
• Chemotherapy for lesions that spread from the spine into nearby tissue.
• Surgery to strengthen the weakened bone by bracing or fusing the bones together.

Treatment of two or more bone lesions may include:

• Chemotherapy and steroid therapy.
• Bisphosphonate therapy.

Treatment of combinations of childhood LCH skin, lymph node, pituitary gland, and bone lesions may include:

• Chemotherapy and steroid therapy.
• Bisphosphonate therapy.

Treatment of childhood LCH multisystem disease lesions in the spleen, liver, or bone marrow (with or without skin, bone, lymph node, lung, or pituitary gland lesions) may include:

• Chemotherapy and steroid therapy. Higher doses of combination chemotherapy and steroid therapy may be given to patients whose tumors do not respond to initial chemotherapy.
• A liver transplant for patients with severe liver damage.

Treatment of childhood LCH central nervous system lesions may include various combinations of the following:

• Chemotherapy with or without steroid therapy.
• Steroid therapy.

Recurrent LCH is disease that cannot be detected for some time after treatment and then comes back. Treatment of recurrent childhood LCH in the skin, bone, lymph nodes, gastrointestinal tract, pituitary gland, or central nervous system (low-risk organs) may include:

• Chemotherapy with or without steroid therapy.
• Bisphosphonate therapy.
• Nonsteroidal anti-inflammatory drug (NSAID) therapy with indomethacin.

Refractory LCH is disease that does not get better with treatment. Treatment of refractory childhood LCH in high-risk organs and in multisystem low-risk organs may include high-dose chemotherapy. Treatment of childhood LCH in multisystem high-risk organs that did not respond to chemotherapy may include stem cell transplant.

Progressive LCH is disease that continues to grow during treatment. Treatment of progressive childhood LCH in patients with multisystem disease may include anticancer drugs that have not been given to the patient before.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood Langerhans cell histiocytosis. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.