Response assessment and disease surveillance recommendations for LCH in adults
| Type of LCH . | First response assessment . | Subsequent assessments . | Comments . |
|---|---|---|---|
| Skin only | Skin exam at each visit | Skin exam at each visit | |
| Bone only | FDG-PET/CT in 2-3 mo | FDG-PET/CT every 3-6 mo* | |
| Pituitary and hypothalamus only | Endocrine evaluation in 3 mo | Endocrine evaluation annually | MRI of pituitary/hypothalamus if initially involved |
| Other unifocal LCH | FDG-PET/CT or CT/MRI in 2-3 mo | FDG-PET/CT or CT/MRI every 3-6 mo* | |
| Single-system PLCH | PFTs and HRCT chest in 3-6 mo† | PFTs and HRCT chest 6-12 mo† | TTE and right-heart catheterization may be needed if suspicion of pulmonary hypertension |
| Multisystem LCH | FDG-PET/CT in 2-3 mo | FDG-PET/CT every 3-6 mo* | Organ-specific imaging (CT or MRI) may be needed depending on organ involvement |
| Type of LCH . | First response assessment . | Subsequent assessments . | Comments . |
|---|---|---|---|
| Skin only | Skin exam at each visit | Skin exam at each visit | |
| Bone only | FDG-PET/CT in 2-3 mo | FDG-PET/CT every 3-6 mo* | |
| Pituitary and hypothalamus only | Endocrine evaluation in 3 mo | Endocrine evaluation annually | MRI of pituitary/hypothalamus if initially involved |
| Other unifocal LCH | FDG-PET/CT or CT/MRI in 2-3 mo | FDG-PET/CT or CT/MRI every 3-6 mo* | |
| Single-system PLCH | PFTs and HRCT chest in 3-6 mo† | PFTs and HRCT chest 6-12 mo† | TTE and right-heart catheterization may be needed if suspicion of pulmonary hypertension |
| Multisystem LCH | FDG-PET/CT in 2-3 mo | FDG-PET/CT every 3-6 mo* | Organ-specific imaging (CT or MRI) may be needed depending on organ involvement |
PFT, pulmonary function tests; TTE, transthoracic echocardiogram.
Once the best response is achieved and disease stabilized, the frequency of testing and imaging studies can be individualized to longer intervals.
Chest radiography can be performed instead of HRCT for follow-up in cases that are mild and do not require treatment. Serial lung HRCT is recommended in patients who exhibit changes in their clinical, functional, or chest radiography findings during follow-up.