{"entity":{"id":"paper-lch-iii-therapy-prolongation-multisystem-lch-blood-2013","kind":"paper","name":"LCH-III: therapy prolongation improves outcome in multisystem Langerhans cell histiocytosis","aka":[],"tldr":"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.\n\nMethotrexate 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.","asOf":"2026-09-18","links":[{"label":"Blood 2013","url":"https://doi.org/10.1182/blood-2012-09-455774"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/23589673/"}],"tags":[],"related":[],"cancers":["lch-single-system","lch-multisystem"],"sections":[],"technologies":[],"targets":[],"drugs":["vinblastine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["lch-iii"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["blood"],"dependsOn":[],"notes":[],"journal":"Blood","year":2013,"doi":"10.1182/blood-2012-09-455774","pmid":"23589673","authors":"Gadner H, Minkov M, Grois N, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true},"route":"/key-papers/paper-lch-iii-therapy-prolongation-multisystem-lch-blood-2013/","neighbours":{"cancer":[{"id":"lch-multisystem","kind":"cancer","name":"Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement)","route":"/cancers/lch-multisystem/"},{"id":"lch-single-system","kind":"cancer","name":"Single-system Langerhans cell histiocytosis (bone, skin or one other organ)","route":"/cancers/lch-single-system/"}],"drug":[{"id":"vinblastine","kind":"drug","name":"Vinblastine","route":"/drugs/vinblastine/"}],"trial":[{"id":"lch-iii","kind":"trial","name":"LCH-III","route":"/trials/lch-iii/"}],"journal":[{"id":"blood","kind":"journal","name":"Blood","route":"/journals/blood/"}]}}