How I Treat How I treat Langerhans cell histiocytosis

“Langerhans cell histiocytosis” (LCH) describes a spectrum of clinical presentations ranging from a single bone lesion or trivial skin rash to an explosive disseminated disease. Regardless of clinical severity, LCH lesions share the common histology of CD1a/CD207 dendritic cells with characteristic morphology among an inflammatory infiltrate. Despite historical uncertainty defining LCH as inflammatory vs neoplastic and incomplete understanding of mechanisms of pathogenesis, clinical outcomeshave improvedmarkedly over the past decades through cooperative randomized clinical trials based on empiric therapeutic strategies. Significant advances include recognition of highand low-risk clinical groups defined by hematopoietic and/or hepatic involvement, and of the importance of optimal intensity and of duration of chemotherapy. Nevertheless, mortality of high-risk patients, disease recurrence, lack of robustly tested salvage strategies, and significant disease morbidity of bothhighand low-risk patients remain challenges. Recent discovery of recurrent somatic mutations in mitogenactivated protein kinase pathway genes at critical stages of myeloid hematopoietic differentiation in LCH patients supports redefinition of the disease as amyeloproliferative disorder and provides opportunities to develop novel approaches to diagnosis and therapy. (Blood. 2015;126(1):26-35)