title: Skeletal Langerhans cell histiocytosis in children: permanent consequences and health-related quality of life in long-term survivors.
abstract: BACKGROUND
  The skeleton is the most frequently involved organ in Langerhans cell histiocytosis (LCH) in children, and bone LCH generally has an excellent long-term survival. Although permanent consequences (PC) are described in half of the survivors thus raising concerns for quality of life (QOL), the impact on quality of life has not been formally studied.
  
  
  METHODS
  A retrospective review was performed on 124 LCH patients with skeletal involvement, followed by prospective evaluation of PC and health-related QOL using age-appropriate validated study tools (PedsQL or SF-36).
  
  
  RESULTS
  Of the 116 survivors, PC were found in 34 (29%) patients, of whom 8 had more than 1 PC. PC were significantly more frequent in multi-system (M-S) than in single system (S-S) LCH (73% vs. 17%; P < 0.0001). While diabetes insipidus (65%) was the most common PC in M-S LCH, cosmetic and orthopedic problems made up the majority of PC in S-S LCH. The median follow-up time was 8.5 years. 27 patients completed the PedsQL survey and 22 the SF-36 survey. The QOL scores for LCH patients were not significantly different from healthy children in the PedsQL survey and from young adults in the SF-36 survey. In addition, the QOL scores were very similar between patients with and without PC and between patients with M-S and S-S LCH.
  
  
  CONCLUSIONS
  Children with M-S LCH had a significantly higher risk of developing PC. Skeletal LCH did not adversely affect the quality of life of survivors, including those with PC who appeared to adapt to their disabilities and medical problems.
authors.affiliation: Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Loretta M S
authors.initials: LM
authors.lastname: Lau
authors.forename: Kyra
authors.initials: K
authors.lastname: Stuurman
authors.forename: Sheila
authors.initials: S
authors.lastname: Weitzman
mesh_terms: D000293:Adolescent; D001847:Bone Diseases / Q000150:complications / Q000453:epidemiology*; D002648:Child; D020790:Diabetes Insipidus, Neurogenic / Q000453:epidemiology / Q000209:etiology; D004644:Emotions; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology; D034381:Hearing Loss / Q000453:epidemiology / Q000209:etiology; D006646:Histiocytosis, Langerhans-Cell / Q000145:classification / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007859:Learning Disabilities / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009864:Ontario / Q000453:epidemiology; D009928:Organ Specificity; D011584:Psychology; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*