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Kachaner A, Seror R, Aubart FC, Henry J, Lazure T, Emile JF, Mariette X, Bitoun S. Complete remission after a single bisphosphonate infusion in isolated bone Langerhans cell histiocytosis lesion: a case report and a narrative review of the literature. JBMR Plus 2024; 8:ziae043. [PMID: 38644976 PMCID: PMC11032215 DOI: 10.1093/jbmrpl/ziae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 04/23/2024] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease with limited treatment options. We present a case involving a 57-year-old woman afflicted with an isolated LCH bone osteolytic lesion. A single bisphosphonate infusion significantly alleviated pain, and follow-up scans via CT, PET-CT, and MRI revealed a substantial recalcification of the lesion. Conducting an extensive literature review, we identified 46 cases documenting the efficacy of bisphosphonates in the context of LCH. These findings have raised interest in bisphosphonate infusion as a simple therapeutic alternative in similar situations, with benefits in terms of bone recalcification and pain control for individuals with LCH.
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Affiliation(s)
- Alexandra Kachaner
- Department of Rheumatology, Paris Saclay University, Bicêtre Hospital, AP-HP, FHU Care, Le Kremlin Bicêtre 94270, France
| | - Raphaèle Seror
- Department of Rheumatology, Paris Saclay University, Bicêtre Hospital, AP-HP, FHU Care, Le Kremlin Bicêtre 94270, France
| | - Fleur Cohen Aubart
- Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytosis, Sorbonne University AP-HP, Pitié-Salpêtrière Hospital, INSERM UMRS-1135 Team 7, Paris 75013, France
| | - Julien Henry
- Department of Rheumatology, Paris Saclay University, Bicêtre Hospital, AP-HP, FHU Care, Le Kremlin Bicêtre 94270, France
| | - Thierry Lazure
- Department of Pathology, Paris Saclay University, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre 94270, France
| | - Jean François Emile
- Paris-Saclay University, Versailles SQY University, EA4340-BECCOH, Assistance Publique–Hôpitaux de Paris (AP-HP), Ambroise-Paré Hospital, Smart Imaging, Service de Pathologie, Boulogne 92100, France
| | - Xavier Mariette
- Department of Rheumatology, Paris Saclay University, Bicêtre Hospital, AP-HP, FHU Care, Le Kremlin Bicêtre 94270, France
| | - Samuel Bitoun
- Department of Rheumatology, Paris Saclay University, Bicêtre Hospital, AP-HP, FHU Care, Le Kremlin Bicêtre 94270, France
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2
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Barnbrock AE, Hutter C, Bochennek K, Minkov M, Lehrnbecher T. [Therapeutic Strategies In Children And Adolescents With Langerhans Cell Histiocytosis]. KLINISCHE PADIATRIE 2023; 235:342-349. [PMID: 37673093 DOI: 10.1055/a-2146-1395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
The current standard therapy for children and adolescents with newly diagnosed Langerhans cell histiocytosis (LCH) is based on the two drugs prednisone and vinblastine. In patients with insufficient treatment response or disease relapse, the choice of second-line treatment depends on risk organ involvement (liver, spleen, and hematopoietic system). This article will give an overview of current data concerning therapeutic options in the different settings of children and adolescents with LCH. Due to limited evidence, these strategies have not been described in detail in the updated guidelines on pediatric LCH. In addition, the use of targeted therapy such as MAP-kinase inhibitors will be discussed. The reference center for LCH should be contacted if therapeutic options beyond the standard regimen are considered for treatment. All children and adolescents with LCH should be enrolled in registries or prospective studies.
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Affiliation(s)
- Anke Elisabeth Barnbrock
- Pädiatrische Hämatologie, Onkologie und Hämostaeologie, Klinik für Kinder- und Jugendmedizin, Goethe-Universität, Frankfurt, Germany
| | - Caroline Hutter
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Medizinische Universität Wien, Wien, Austria
| | - Konrad Bochennek
- Pädiatrische Hämatologie, Onkologie und Hämostaeologie, Klinik für Kinder- und Jugendmedizin, Goethe-Universität, Frankfurt, Germany
| | - Milen Minkov
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Medizinische Universität Wien, Wien, Austria
| | - Thomas Lehrnbecher
- Pädiatrische Hämatologie, Onkologie und Hämostaeologie, Klinik für Kinder- und Jugendmedizin, Goethe-Universität, Frankfurt, Germany
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3
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Rocamora-Blanch G, Climent F, Solanich X. [Histiocytosis]. Med Clin (Barc) 2023; 161:166-175. [PMID: 37263840 DOI: 10.1016/j.medcli.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
Histiocytosis is a group of rare diseases characterized by inflammation and accumulation of cells derived from monocytes and macrophages in different tissues. The symptoms are highly variable, from mild forms with involvement of a single organ to severe multisystem forms that can be life compromising. The diagnosis of histiocytosis is based on the clinic, radiological findings and pathological anatomy. A biopsy of the affected tissue is recommended in all cases as it may have therapeutic implications. During the last decade, some mutations have been identified in the affected tissue that condition activation of the MAPK/ERK and PI3K/AKT pathway, in a variable proportion depending on the type of histiocytosis. In this review we mainly focus on Langerhans Cell Histiocytosis, Erdheim-Chester Disease and Rosai-Dorfman Disease.
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Affiliation(s)
- Gemma Rocamora-Blanch
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
| | - Fina Climent
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Xavier Solanich
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
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4
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Potapenko VG, Baykov VV, Zinchenko AV, Potikhonova NA. Langerhans cell histiocytosis in adults: literature review. ONCOHEMATOLOGY 2022. [DOI: 10.17650/1818-8346-2022-17-4-16-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Langerhans cells histiocytosis is a variant of malignant histiocytosis. The course and symptoms vary. patients with localized forms have a better prognosis, because local therapy is effective. patients with multifocal forms of histiocytosis receive systemic drug therapy, which cures some of the patients. This review provides up-to-date data about typical presentation of the organ involvement, diagnosis, course and therapy of various forms of Langerhans cells histiocytosis.
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Affiliation(s)
| | - V. V. Baykov
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - A. V. Zinchenko
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - N. A. Potikhonova
- Russian Research Institute of Hematology and Transfusiology, Federal Medical and Biological Agency
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5
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Rajkumar K, Viswambaran M, Sen A, Chattopadhyay PK. Bisphosphonate Osteonecrosis in a Case of Langerhans Cell Histiocytosis: Report of a Case and Review of Literature. J Maxillofac Oral Surg 2022; 21:1001-1006. [PMID: 36274899 PMCID: PMC9474799 DOI: 10.1007/s12663-021-01625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022] Open
Abstract
Langerhans Cell histiocytosis is a rare multisystem disease originating from dendritic cell lines primarily characterized by osteolytic lesion of the skeleton. Chemotherapy along with bisphosphonates have been used to control the progression of the disease and prevent the osteolysis associated with the disease. Bisphosphonate osteonecrosis of the jaws is a common finding following treatment with bisphosphonates for osteoporosis, metastatic tumors to the bone or the osteolytic lesions of multiple myeloma. The article highlights a rare case of bisphosphonate osteonecrosis of the mandible in a case of long-standing Langerhans cell histiocytosis.
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Affiliation(s)
- K. Rajkumar
- Oral and Maxillofacial Surgery, Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - M. Viswambaran
- AFIDS and Dental Adviser (Air), Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - Arijit Sen
- Pathology and Lab Sciences, Command Hospital (AF), Bangalore, India
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6
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Goyal G, Tazi A, Go RS, Rech KL, Picarsic JL, Vassallo R, Young JR, Cox CW, Van Laar J, Hermiston ML, Cao XX, Makras P, Kaltsas G, Haroche J, Collin M, McClain KL, Diamond EL, Girschikofsky M. International expert consensus recommendations for the diagnosis and treatment of Langerhans cell histiocytosis in adults. Blood 2022; 139:2601-2621. [PMID: 35271698 PMCID: PMC11022927 DOI: 10.1182/blood.2021014343] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/24/2022] [Indexed: 11/20/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) can affect children and adults with a wide variety of clinical manifestations, including unifocal, single-system multifocal, single-system pulmonary (smoking-associated), or multisystem disease. The existing paradigms in the management of LCH in adults are mostly derived from the pediatric literature. Over the last decade, the discovery of clonality and MAPK-ERK pathway mutations in most cases led to the recognition of LCH as a hematopoietic neoplasm, opening the doors for treatment with targeted therapies. These advances have necessitated an update of the existing recommendations for the diagnosis and treatment of LCH in adults. This document presents consensus recommendations that resulted from the discussions at the annual Histiocyte Society meeting in 2019, encompassing clinical features, classification, diagnostic criteria, treatment algorithm, and response assessment for adults with LCH. The recommendations favor the use of 18F-Fluorodeoxyglucose positron emission tomography-based imaging for staging and response assessment in the majority of cases. Most adults with unifocal disease may be cured by local therapies, while the first-line treatment for single-system pulmonary LCH remains smoking cessation. Among patients not amenable or unresponsive to these treatments and/or have multifocal and multisystem disease, systemic treatments are recommended. Preferred systemic treatments in adults with LCH include cladribine or cytarabine, with the emerging role of targeted (BRAF and MEK inhibitor) therapies. Despite documented responses to treatments, many patients struggle with a high symptom burden from pain, fatigue, and mood disorders that should be acknowledged and managed appropriately.
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Affiliation(s)
- Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abdellatif Tazi
- Université de Paris, INSERM UMR 976, Saint Louis Research Institute, Paris, France
- French National Reference Center for Histiocytoses, Department of Pulmonology, Saint-Louis Teaching Hospital, Assistance Publique-Hôpiaux de Paris, Paris, France
| | | | - Karen L. Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jennifer L. Picarsic
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | - Jan Van Laar
- Department of Internal Medicine
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michelle L. Hermiston
- Division of Pediatric Hematology-Oncology, University of California, San Francisco, San Francisco, CA
| | - Xin-Xin Cao
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Polyzois Makras
- LCH Adult Clinic
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Gregory Kaltsas
- 1st Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Greece
| | - Julien Haroche
- Service de médecine interne 2, Centre de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Matthew Collin
- Newcastle University and Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, United Kingdom
| | - Kenneth L. McClain
- Texas Children's Cancer and Hematology Centers, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Girschikofsky
- Internal Medicine I (Hemostasis, Hematology and Stem, Cell Transplantation and Medical Oncology), Ordensklinikum Linz Elisabethinen, Linz, Austria
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7
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Georgakopoulou D, Anastasilakis AD, Makras P. Adult Langerhans Cell Histiocytosis and the Skeleton. J Clin Med 2022; 11:jcm11040909. [PMID: 35207181 PMCID: PMC8875624 DOI: 10.3390/jcm11040909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 02/05/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare inflammatory neoplasia in which somatic mutations in components of the MAPK/ERK pathway have been identified. Osseous involvement is evident in approximately 80% of all patients and may present as a single osteolytic lesion, as a multi-ostotic single system disease or as part of multisystem disease. Both exogenous, such as treatment with glucocorticoids, and endogenous parameters, such as anterior pituitary hormone deficiencies and inflammatory cytokines, may severely affect bone metabolism in LCH. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually required to precisely assess the degree of bone involvement; 18F-fluorodeoxyglucose (FDG) positron emission tomography-CT can both detect otherwise undetectable LCH lesions and differentiate metabolically active from inactive or resolved disease, while concomitantly being useful in the assessment of treatment response. Treatment of skeletal involvement may vary depending on location, extent, size, and symptoms of the disease from close observation and follow-up in unifocal single-system disease to chemotherapy and gene-targeted treatment in cases with multisystem involvement. In any case of osseous involvement, bisphosphonates might be considered as a treatment option especially if pain relief is urgently needed. Finally, a patient-specific approach is suggested to avoid unnecessary extensive surgical interventions and/or medical overtreatment.
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Affiliation(s)
- Danae Georgakopoulou
- LCH Adult Clinic, 251 Hellenic Air Force & VA General Hospital, 11525 Athens, Greece;
| | | | - Polyzois Makras
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, 11525 Athens, Greece
- Correspondence: ; Tel.: +30-210-7463606
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8
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Go RS, Jacobsen E, Baiocchi R, Buhtoiarov I, Butler EB, Campbell PK, Coulter DW, Diamond E, Flagg A, Goodman AM, Goyal G, Gratzinger D, Hendrie PC, Higman M, Hogarty MD, Janku F, Karmali R, Morgan D, Raldow AC, Stefanovic A, Tantravahi SK, Walkovich K, Zhang L, Bergman MA, Darlow SD. Histiocytic Neoplasms, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1277-1303. [PMID: 34781268 DOI: 10.6004/jnccn.2021.0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Histiocytic neoplasms are rare hematologic disorders accounting for less than 1% of cancers of the soft tissue and lymph nodes. Clinical presentation and prognosis of these disorders can be highly variable, leading to challenges for diagnosis and optimal management of these patients. Treatment often consists of systemic therapy, and recent studies support use of targeted therapies for patients with these disorders. Observation ("watch and wait") may be sufficient for select patients with mild disease. These NCCN Guidelines for Histiocytic Neoplasms include recommendations for diagnosis and treatment of adults with the most common histiocytic disorders: Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai-Dorfman disease.
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Affiliation(s)
| | - Eric Jacobsen
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Robert Baiocchi
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Ilia Buhtoiarov
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Cleveland Clinic Children's Hospital
| | | | - Patrick K Campbell
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Aron Flagg
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - Paul C Hendrie
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Filip Janku
- The University of Texas MD Anderson Cancer Center
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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9
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Recurrent Skin Langerhan Cell Histiocytosis Successfully Treated With Indomethacin Monotherapy. J Pediatr Hematol Oncol 2020; 42:e795-e797. [PMID: 30951019 DOI: 10.1097/mph.0000000000001474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Langerhans cell histiocytosis (LCH) often has a recurrent and refractory course despite multiagent treatment modalities. Common relapse treatments include intense or prolonged cytotoxic chemotherapy regimens. There are a few prior reports that the nonsteroidal anti-inflammatory drug indomethacin demonstrated activity against bone LCH. Here we report indomethacin as a successful treatment for a case of chronic skin LCH that failed multiple prior chemotherapy regimens. This experience supports the need for trials to investigate indomethacin as a treatment for LCH both in the relapsed or refractory setting as well as potential combination or maintenance therapy in newly diagnosed patients.
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10
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Yoon HS. A Recent Update on Histiocytic Disorder in Children: Focus on Diagnosis and Treatment. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2020. [DOI: 10.15264/cpho.2020.27.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hoi Soo Yoon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Korea
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11
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Kudo K, Tanaka T, Kobayashi A, Terui K, Ito E. Zoledronic acid for relapsed Langerhans cell histiocytosis with isolated skull bone lesion. Pediatr Int 2019; 61:315-317. [PMID: 30793439 DOI: 10.1111/ped.13774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/06/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ko Kudo
- Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Tatsuhiko Tanaka
- Department of Pediatrics, Aomori Prefecture Hospital, Aomori, Japan
| | - Akie Kobayashi
- Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Kiminori Terui
- Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Etsuro Ito
- Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan
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12
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Murakami I, Wada N, Nakashima J, Iguchi M, Toi M, Hashida Y, Higuchi T, Daibata M, Matsushita M, Iwasaki T, Kuwamoto S, Horie Y, Nagata K, Hayashi K, Oka T, Yoshino T, Imamura T, Morimoto A, Imashuku S, Gogusev J, Jaubert F. Merkel cell polyomavirus and Langerhans cell neoplasm. Cell Commun Signal 2018; 16:49. [PMID: 30134914 PMCID: PMC6103986 DOI: 10.1186/s12964-018-0261-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The relationship between various external agents such as pollen, food, and infectious agents and human sensitivity exists and is variable depending upon individual's health conditions. For example, we believe that the pathogenetic potential of the Merkel cell polyomavirus (MCPyV), the resident virus in skin, is variable and depends from the degree of individual's reactivity. MCPyV as well as Epstein-Barr virus, which are normally connected with humans under the form of subclinical infection, are thought to be involved at various degrees in several neoplastic and inflammatory diseases. In this review, we cover two types of Langerhans cell neoplasms, the Langerhans cell sarcoma (LCS) and Langerhans cell histiocytosis (LCH), represented as either neoplastic or inflammatory diseases caused by MCPyV. METHODS We meta-analyzed both our previous analyses, composed of quantitative PCR for MCPyV-DNA, proteomics, immunohistochemistry which construct IL-17 endocrine model and interleukin-1 (IL-1) activation loop model, and other groups' data. RESULTS We have shown that there were subgroups associated with the MCPyV as a causal agent in these two different neoplasms. Comparatively, LCS, distinct from the LCH, is a neoplastic lesion (or sarcoma) without presence of inflammatory granuloma frequently observed in the elderly. LCH is a proliferative disease of Langerhans-like abnormal cells which carry mutations of genes involved in the RAS/MAPK signaling pathway. We found that MCPyV may be involved in the development of LCH. CONCLUSION We hypothesized that a subgroup of LCS developed according the same mechanism involved in Merkel cell carcinoma pathogenesis. We proposed LCH developed from an inflammatory process that was sustained due to gene mutations. We hypothesized that MCPyV infection triggered an IL-1 activation loop that lies beneath the pathogenesis of LCH and propose a new triple-factor model.
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Affiliation(s)
- Ichiro Murakami
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Noriko Wada
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Junko Nakashima
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Mitsuko Iguchi
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Makoto Toi
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Michiko Matsushita
- Department of Pathobiological Science and Technology, School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Takeshi Iwasaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582 Japan
| | - Satoshi Kuwamoto
- Department of Pathology, Tottori University Hospital, 86 Nishi, Yonago, Tottori, 683-8503 Japan
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Yasushi Horie
- Department of Pathology, Tottori University Hospital, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Keiko Nagata
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Kazuhiko Hayashi
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Takashi Oka
- Department of Virology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama, Okayama 700-8558 Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama, Okayama 700-8558 Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566 Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima, Uji, Kyoto, 611-0041 Japan
| | - Jean Gogusev
- Inserm U507 and U1016, Institut Cochin, 75014 Paris, France
| | - Francis Jaubert
- AP-HP Hôpital Necker-Enfants Malades, University Paris Descartes (Paris 5), 75006 Paris, France
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13
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Anghelescu DL, Pankayatselvan V, Nguyen R, Ward D, Wu J, Wu H, Edwards DD, Furman W. Bisphosphonate Use in Pediatric Oncology for Pain Management. Am J Hosp Palliat Care 2018; 36:138-142. [PMID: 30114925 DOI: 10.1177/1049909118793114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The use of bisphosphonates for pain control in children with cancer is not extensively studied. We retrospectively evaluated 35 children with cancer treated with intravenous bisphosphonates for pain management at a single institution from 1998 through 2015. We analyzed pain scores and opioid and adjuvant medication consumption before bisphosphonate administration, daily for 2 weeks, and at 3 and 4 weeks after administration. We also determined the time interval between diagnosis and first administration of bisphosphonates and duration of life after bisphosphonate administration. Mean pain scores were 2.45 (±2.96) and 0.75 (±1.69) before and 14 days after bisphosphonate administration, respectively ( P = .25), and morphine equivalent doses of opioids were 5.52 (±13.35) and 5.27 (±9.77), respectively ( P = .07). Opioid consumption was significantly decreased at days 4 to 8, days 11 to 12, and week 3 after first bisphosphonate administration. The median duration of life after first bisphosphonate administration was 80 days, indicating its use late in the course of treatment. Bisphosphonates did not significantly improve pain outcomes at 2 weeks, but opioid consumption was reduced at several time points during the first 3 weeks. The use of bisphosphonates earlier in the course of pediatric oncological disease should be evaluated in prospective investigations.
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Affiliation(s)
- Doralina L Anghelescu
- 1 Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Varayini Pankayatselvan
- 1 Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rosa Nguyen
- 2 Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Deborah Ward
- 3 Department of Pharmacological Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jianrong Wu
- 4 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Huiyun Wu
- 4 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Denaya D Edwards
- 1 Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Wayne Furman
- 2 Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
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Anastasilakis AD, Tsoli M, Kaltsas G, Makras P. Bone metabolism in Langerhans cell histiocytosis. Endocr Connect 2018; 7:R246-R253. [PMID: 29967185 PMCID: PMC6063875 DOI: 10.1530/ec-18-0186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease of not well-defined etiology that involves immune cell activation and frequently affects the skeleton. Bone involvement in LCH usually presents in the form of osteolytic lesions along with low bone mineral density. Various molecules involved in bone metabolism are implicated in the pathogenesis of LCH or may be affected during the course of the disease, including interleukins (ILs), tumor necrosis factor α, receptor activator of NF-κB (RANK) and its soluble ligand RANKL, osteoprotegerin (OPG), periostin and sclerostin. Among them IL-17A, periostin and RANKL have been proposed as potential serum biomarkers for LCH, particularly as the interaction between RANK, RANKL and OPG not only regulates bone homeostasis through its effects on the osteoclasts but also affects the activation and survival of immune cells. Significant changes in circulating and lesional RANKL levels have been observed in LCH patients irrespective of bone involvement. Standard LCH management includes local or systematic administration of corticosteroids and chemotherapy. Given the implication of RANK, RANKL and OPG in the pathogenesis of the disease and the osteolytic nature of bone lesions, agents aiming at inhibiting the RANKL pathway and/or osteoclastic activation, such as bisphosphonates and denosumab, may have a role in the therapeutic approach of LCH although further clinical investigation is warranted.
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Affiliation(s)
| | - Marina Tsoli
- 1st Propaedeutic Department of Internal MedicineNational and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- 1st Propaedeutic Department of Internal MedicineNational and Kapodistrian University of Athens, Athens, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes251 Hellenic Air Force & VA General Hospital, Athens, Greece
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15
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Anastasilakis AD, Polyzos SA, Tsoli M, Papatheodorou A, Kokkoris P, Kaltsas G, Terpos E, Makras P. Low periostin levels in adult patients with Langerhans cell histiocytosis are independently associated with the disease activity. Metabolism 2017; 71:198-201. [PMID: 28521873 DOI: 10.1016/j.metabol.2017.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Langerhans cell histiocytosis (LCH) is a rare proliferative disease of cells of the CD1a+/CD207+ myeloid dendritic cell lineage that may infiltrate one or more organs or systems at all ages. We aimed to evaluate periostin and sclerostin serum levels in adult patients with LCH. PROCEDURES This was a cross-sectional study comparing 38 adult patients with LCH with 38 age- and sex-matched healthy controls. Serum periostin and sclerostin levels were measured to compare between LCH patients and controls as well as between patients with active and non-active disease. RESULTS Serum periostin levels were significantly lower in LCH patients than controls (457±72ng/ml vs. 721±79ng/ml, p=0.014) but this was not the case for sclerostin levels which did not differ between patients and controls, respectively (29.0±1.8pmol/L vs. 39.5±3.8pmol/L, p=0.12). Patients with active disease had significantly lower periostin levels than those with inactive disease (240±78ng/ml vs. 558±94ng/ml, p=0.008). No effect of specific site involvement, extend of disease, or treatment administered was found on any of the above parameters measured. CONCLUSIONS Lower serum periostin levels were observed in adult LCH patients with active disease. The finding warrants further investigation to define whether periostin could serve as a serum biomarker for LCH activity.
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Affiliation(s)
| | - Stergios A Polyzos
- Department of Endocrinology, Ippokration General Hospital, Thessaloniki, Greece
| | - Marina Tsoli
- Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Kokkoris
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece; Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Gregory Kaltsas
- Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodostrian University of Athens School of Medicine, Athens, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, Athens, Greece.
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