title: Predictors of outcome in children with Langerhans cell histiocytosis.
abstract: BACKGROUND
  Our goal was to examine the clinical course of patients with Langerhans cell histiocytosis (LCH), with a special emphasis on bone disease and to attempt to identify and examine the factors that may predict reactivation and overall prognosis.
  
  
  METHODS
  We conducted a retrospective chart review of 132 consecutive pediatric patients treated at Children's Hospital Los Angeles for LCH from 1984 to 2001.
  
  
  RESULTS
  The risk for reactivation after initial management is significantly higher for patients with multiple bone and those with multiple organ involvement as compared with patients who had a single bone lesion (hazard ratios are 7.1 and 11.6). Patients younger than 1 year in the multiple organ group have an increased risk of death at 2 years when compared with the older patients in that group (hazard ration = 6.2, P = 0.022). Endocrine abnormalities were seen in 20% and 7.5% of patients with or without skull lesions respectively.
  
  
  CONCLUSIONS
  Patients with LCH involving only the bones have a significantly better outcome than those with other organ involvement. Patients with multiple organ involvement who are less than 1 year of age are at high risk of death and should be approached more aggressively upfront.
authors.affiliation: Keck School of Medicine, University of Southern California, Division of Pediatric Hematology/Oncology, Children's Hospital Los Angeles, USA. rjubran@chla.usc.edu
authors.forename: Rima F
authors.initials: RF
authors.lastname: Jubran
authors.forename: Araz
authors.initials: A
authors.lastname: Marachelian
authors.forename: Frederick
authors.initials: F
authors.lastname: Dorey
authors.forename: Marcio
authors.initials: M
authors.lastname: Malogolowkin
mesh_terms: D000293:Adolescent; D000328:Adult; D001847:Bone Diseases / Q000175:diagnosis / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007223:Infant; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate