# LCH-III: therapy prolongation improves outcome in multisystem Langerhans cell histiocytosis

Source: https://onco.cc/key-papers/paper-lch-iii-therapy-prolongation-multisystem-lch-blood-2013/  
OnCo record `paper-lch-iii-therapy-prolongation-multisystem-lch-blood-2013` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Twelve months of vinblastine and prednisone, rather than six, meant fewer children's Langerhans cell histiocytosis came back, and mortality in the highest-risk children fell to a fraction of what it had been.

## Summary

International randomised trial of the Histiocyte Society in children with multisystem Langerhans cell histiocytosis: patients with risk-organ involvement were randomised to vinblastine and prednisone with or without methotrexate, and those without risk-organ involvement to six or twelve months of treatment.

Methotrexate added no benefit, while twelve months of therapy roughly halved the five-year reactivation rate compared with six months (about 37 versus 54 percent). Mortality in risk-organ-positive patients fell to about 15 percent with early switching of non-responders to salvage. Twelve months of vinblastine and prednisone became the international standard.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: Blood
- Year: 2013
- DOI: 10.1182/blood-2012-09-455774
- Authors: Gadner H, Minkov M, Grois N, et al.
- Findings: Twelve months of vinblastine and prednisone reduced five-year reactivation to about 37 percent from about 54 percent with six months.; Adding methotrexate did not improve outcomes in risk-organ-positive patients.
- What it means: Children with multisystem LCH receive a year of vinblastine and prednisone, and those in whom the disease does not respond quickly are switched early to salvage therapy.
- Caveats: Reactivation remains common even after twelve months, and late effects such as neurodegeneration are not prevented.; Adults were not studied; adult regimens are extrapolated.

## Sources

- Blood 2013: https://doi.org/10.1182/blood-2012-09-455774
- PubMed: https://pubmed.ncbi.nlm.nih.gov/23589673/

## Connected records

- cancers: [Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement)](https://onco.cc/cancers/lch-multisystem/), [Single-system Langerhans cell histiocytosis (bone, skin or one other organ)](https://onco.cc/cancers/lch-single-system/)
- drugs: [Vinblastine](https://onco.cc/drugs/vinblastine/)
- trials: [LCH-III](https://onco.cc/trials/lch-iii/)
- journals: [Blood](https://onco.cc/journals/blood/)

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