title: Clinical outcomes of pulmonary Langerhans'-cell histiocytosis in adults.
abstract: BACKGROUND
  Pulmonary Langerhans'-cell histiocytosis is an uncommon interstitial lung disease in adults. It has an unpredictable course and may be associated with an increased susceptibility to the development of malignant neoplasms.
  
  
  METHODS
  We reviewed the records of 102 adults with histopathologically confirmed pulmonary Langerhans'-cell histiocytosis to ascertain their vital status and whether cancer had been diagnosed. The health status of surviving patients was quantified with the use of the 36-Item Short-Form General Health Survey. Factors potentially associated with survival after the diagnosis of pulmonary Langerhans'-cell histiocytosis were analyzed with the Cox proportional-hazards model.
  
  
  RESULTS
  The median follow-up period was 4 years (range, 0 to 23). There were 33 deaths, 15 of which were attributable to respiratory failure. Six hematologic cancers were diagnosed. The overall median survival was 12.5 years, which was significantly shorter than that expected for persons of the same sex and calendar year of birth (P<0.001). In a univariate analysis, variables predictive of shorter survival included an older age (P=0.003), a lower forced expiratory volume in one second (FEV1) (P=0.004), a higher residual volume (P=0.007), a lower ratio of FEV1 to forced vital capacity (P=0.03), and a reduced carbon monoxide diffusing capacity (P=0.001).
  
  
  CONCLUSIONS
  The survival of adults with pulmonary Langerhans'-cell histiocytosis is shorter than that in the general population, and respiratory failure accounts for a substantial proportion of deaths among such patients.
authors.affiliation: Thoracic Diseases Research Unit, Division of Pulmonary, Critical Care, and Internal Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA. vassallo.robert@mayo.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Vassallo
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Paul A
authors.initials: PA
authors.lastname: Decker
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Limper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006646:Histiocytosis, Langerhans-Cell / Q000150:complications / Q000401:mortality*; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D016016:Proportional Hazards Models; D011788:Quality of Life; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis