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Langerhans Cell Histiocytosis Treatment (PDQ®): Treatment - Patient Information [NCI] - Treatment Options for LCH in Children

Treatment of Low-Risk Disease in Children

Skin Lesions

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Overview

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

  • Observation.

When severe rashes, pain, ulceration, or bleeding occur, treatment may include the following:

  • Steroid therapy.
  • Chemotherapy, given by mouth.
  • Nitrogen mustard applied to the skin.
  • Photodynamic therapy with psoralen and ultraviolet A (PUVA) therapy.
  • UVB radiation therapy.

Lesions in Bones or Other Low-Risk Organs

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.
  • Low-dose radiation therapy for lesions that affect nearby organs.

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

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

Treatment of childhood LCH lesions of the spine or thigh bone lesions may include:

  • Observation.
  • Low-dose 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.

Treatment of two or more bone lesions combined with childhood LCH skin lesions, lymph node lesions, or diabetes insipidus may include:

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

Treatment of High-Risk Disease in Children

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 (CNS) lesions may include:

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

Treatment of LCH CNS neurodegenerative syndrome may include:

  • Retinoid therapy.
  • Chemotherapy.

Treatment Options for Recurrent, Refractory, and Progressive Childhood LCH in Children

Recurrent LCH is cancer 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.
  • A clinical trial of a targeted therapy.
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