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LCH-IV, międzynarodowy protokół współpracy w leczeniu dzieci i młodzieży z histiocytozą z komórek Langerhansa

9 listopada 2026 zaktualizowane przez: North American Consortium for Histiocytosis

The LCH-IV is an international, multicenter, prospective clinical study for pediatric Langerhans Cell Histiocytosis LCH (age < 18 years).

Przegląd badań

Status

Aktywny, nie rekrutujący

Warunki

Interwencja / Leczenie

Szczegółowy opis

The international efforts of the past 20 years have shown that combination therapy with vinblastine and prednisone is an effective therapy for Multi-system (MS)-LCH. The previous prospective trial LCH-III confirmed this regimen as a standard regimen for MS-LCH in patients with and without risk organ involvement. It also showed that prolonged treatment in the latter group (treatment duration of 12 vs. 6 months) is superior in preventing disease reactivations. The results of this trial are encouraging and serve as a basis for the LCH-IV study design.Due to the complexity of the disease presentations and outcomes, the LCH-IV study seeks to tailor treatment based on features at presentation and on response to treatment, leading to seven strata:

  • Stratum I: First-line treatment for MS-LCH patients (Group 1) and patients with Single system (SS)-LCH with multifocal bone or "Central Nervous System (CNS)-risk" lesions (Group 2)
  • Stratum II: Second-line treatment for non-risk patients (patients without risk organ involvement who fail first-line therapy or have a reactivation after completion of first-line therapy)
  • Stratum III: Salvage treatment for risk LCH (patients with dysfunction of risk organs who fail first-line therapy)
  • Stratum IV: Stem cell transplantation for risk LCH (patients with dysfunction of risk organs who fail first-line therapy)
  • Stratum V: Monitoring and treatment of isolated tumorous and neurodegenerative CNS-LCH
  • Stratum VI: Natural history and management of "other" SS-LCH (patients who do not need systemic therapy at the time of diagnosis)
  • Stratum VII: Long-term Follow up (all patients irrespective of previous therapy will be followed for reactivation or permanent consequences once complete disease resolution has been achieved and the respective protocol treatment completed)

Typ studiów

Interwencyjne

Zapisy (Rzeczywisty)

1400

Faza

  • Faza 2
  • Faza 3

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

    • Alabama
      • Birmingham, Alabama, Stany Zjednoczone, 35233
        • Children's of Alabama
    • Arizona
      • Phoenix, Arizona, Stany Zjednoczone, 85006
        • Phoenix Children's Hospital
    • Arkansas
      • Little Rock, Arkansas, Stany Zjednoczone, 72202
        • Arkansas Children's Hospital
    • California
      • Los Angeles, California, Stany Zjednoczone, 90027
        • Children's Hospital of Los Angeles
      • Madera, California, Stany Zjednoczone, 93636
        • Valley Children's Healthcare
      • Oakland, California, Stany Zjednoczone, 94609
        • UCSF Benioff Children's Hospital of Oakland
      • Orange, California, Stany Zjednoczone, 92868
        • Children's Hospital of Orange County
      • San Francisco, California, Stany Zjednoczone, 94158-0106
        • UCSF Helen Diller Family Cancer Center
    • Connecticut
      • Hartford, Connecticut, Stany Zjednoczone, 06106
        • Connecticut Children's Medical Center
    • District of Columbia
      • Washington D.C., District of Columbia, Stany Zjednoczone, 20010
        • Children's National Medical Center
    • Florida
      • St. Petersburg, Florida, Stany Zjednoczone, 33701
        • Johns Hopkins All Children's Hospital
    • Georgia
      • Atlanta, Georgia, Stany Zjednoczone, 30342
        • Children's Healthcare of Atlanta, Emory
    • Illinois
      • Chicago, Illinois, Stany Zjednoczone, 60611-2991
        • Ann & Robert H. Lurie Children's Hospital of Chicago
    • Indiana
      • Indianapolis, Indiana, Stany Zjednoczone, 46202
        • Riley Hospital for Children - Indiana University
    • Kansas
      • Kansas City, Kansas, Stany Zjednoczone, 64108
        • Children's Mercy Hospitals
    • Kentucky
      • Lexington, Kentucky, Stany Zjednoczone, 40536
        • University of Kentucky A.B.Chandler Medical Center
      • Louisville, Kentucky, Stany Zjednoczone, 40202
        • University of Louisville, Norton Children's Hospital
    • Maryland
      • Baltimore, Maryland, Stany Zjednoczone, 21287
        • Johns Hopkins University
    • Massachusetts
      • Boston, Massachusetts, Stany Zjednoczone, 02114
        • Massachusetts General Hospital
      • Boston, Massachusetts, Stany Zjednoczone, 02115
        • Dana Farber Cancer Institute
    • Minnesota
      • Minneapolis, Minnesota, Stany Zjednoczone, 55404
        • Children's Minnesota
    • New Jersey
      • Hackensack, New Jersey, Stany Zjednoczone, 07601
        • Hackensack University Medical Center
    • New York
      • New Hyde Park, New York, Stany Zjednoczone, 11040
        • Cohen Children's Medical Center
      • New York, New York, Stany Zjednoczone, 10029
        • Mount Sinai Hospital
      • New York, New York, Stany Zjednoczone, 10032
        • Columbia University / Herbert Irving Cancer Center
      • New York, New York, Stany Zjednoczone, 10170
        • Memorial Sloan Kettering Cancer Center
      • Syracuse, New York, Stany Zjednoczone, 13210
        • SUNY Upstate Medical University
      • The Bronx, New York, Stany Zjednoczone, 10467
        • Children's Hospital at Montefiore
    • North Carolina
      • Charlotte, North Carolina, Stany Zjednoczone, 28203
        • Carolinas Medical Center, Levine Children's Hospital
    • Ohio
      • Akron, Ohio, Stany Zjednoczone, 44308
        • Akron Children's Hospital
      • Cincinnati, Ohio, Stany Zjednoczone, 45229
        • Cincinnati Children's Hospital Medical Center
      • Cleveland, Ohio, Stany Zjednoczone, 44106
        • Rainbow Babies & Children's Hospital, University Hospitals
      • Toledo, Ohio, Stany Zjednoczone, 43606
        • Russell J Ebeid Children's Hospital (Promedica)
    • Pennsylvania
      • Pittsburgh, Pennsylvania, Stany Zjednoczone, 15224
        • UPMC Children's Hospital of Pittsburgh
    • South Carolina
      • Charleston, South Carolina, Stany Zjednoczone, 29425
        • Medical University of South Carolina (MUSC)
      • Greenville, South Carolina, Stany Zjednoczone, 29605
        • Greenville Health System BI-LO Charities Children's Cancer Center
    • Tennessee
      • Memphis, Tennessee, Stany Zjednoczone, 38105
        • St. Jude Children's Research Hospital
      • Nashville, Tennessee, Stany Zjednoczone, 37232
        • Vanderbilt-Ingram Cancer Center
    • Texas
      • Dallas, Texas, Stany Zjednoczone, 75235
        • Children's Medical Center Dallas, UT Southwestern
    • Washington
      • Spokane, Washington, Stany Zjednoczone, 99204
        • Providence Sacred Heart Children's Hospital
      • Tacoma, Washington, Stany Zjednoczone, 98431
        • Madigan Army Medical Center
    • Wisconsin
      • Madison, Wisconsin, Stany Zjednoczone, 53792
        • American Family Children's Hospital University of Wisconsin

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

Nie starszy niż 18 lat (Dziecko, Dorosły)

Akceptuje zdrowych ochotników

Nie

Płeć kwalifikująca się do nauki

Wszystko

Opis

Inclusion Criteria:

  • Stratum I

    • Patients must be less than 18 years of age at the time of diagnosis.
    • Patients must have histological verification of the diagnosis of Langerhans cell histiocytosis according to the criteria described in Section 6.1
    • Signed informed consent form
  • Stratum II

    • Patients of Stratum I who have:
    • Progressive disease (AD worse) in non-risk organs after 6 weeks (Initial Course
    • AD intermediate or worse in non-risk organs or AD better in risk organs after 12 weeks (Initial Course 2)
    • Disease progression (AD worse) in non-risk organs at any time during continuation treatment
    • Active disease at the end of Stratum I treatment
    • Disease reactivation in non-risk organs at any time after completion of Stratum I treatment
  • Stratum III

    • Patients from Stratum I who fulfill the following criteria:

    • AD worse in risk organs after week 6 (after Initial Course 1), or AD worse or AD intermediate in risk organs after week 12 (after Initial Course 2).

    • Presence of unequivocally severe organ dysfunction at the above mentioned evaluation points (hematological dysfunction, liver dysfunction, or both of them) as

      • Hb <70 g/L (<7.0 g/dl) and/or transfusion dependency
      • PLT <20 x109/L (20,000/μL) and/or transfusion dependency (both criteria have to be fulfilled) AND/OR
      • Liver dysfunction (or digestive involvement with protein loss)
      • Total protein <55 g/L or substitution dependency
      • Albumin <25 g/L or substitution dependency (at least one of the two criteria to be fulfilled)
  • Stratum IV

    • Patients from Stratum I or Stratum III who fulfill the following criteria:
    • AD worse in risk organs after week 6 (after Initial Course 1), or AD worse or AD intermediate in risk organs after week 12 (after Initial Course 2) of Stratum I OR
    • AD worse after the 2nd and 3rd 2-CdA/Ara-C course, and those AD worse or AD intermediate after the 4th 2-CdA/Ara-C course of Stratum III AND
    • Presence of unequivocally severe organ dysfunction at the above mentioned evaluation points (hematological dysfunction, liver dysfunction, or both of them) as defined in Table XI (see Section 10.3.1).
    • Informed consent: All patients or their legal guardians (if the patient is <18 years of age) must sign an Ethics or institutional Review Board approved consent form indicating their awareness of the investigational nature and the risks of this study. When appropriate, younger patients will be included in all discussions in order to obtain assent.
    • Adequate organ function: Patients should have adequate hepatic, renal, cardiac and pulmonary function to undergo reduced intensity HCT based upon local institutional guidelines, or at a minimum meet requirements noted in eligibility checklist Appendix A-VIII_1. However, significant hepatic and pulmonary dysfunction, if secondary to underlying LCH disease activity, will not exclude patients from protocol enrollment and should be discussed with the National PI Coordinator and the Coordinating Principal Investigator.
  • Stratum V

    • All patients with verified diagnosis of LCH and MRI findings consistent with ND-CNSLCH irrespective of previous treatments (also those not registered to other Strata ofLCH-IV).
    • Patients with isolated tumorous CNS-LCH (including isolated DI with mass lesion in the hypothalamus-pituitary axis). In patients with already established diagnosis of LCH and radiologic finding of CNS lesions compatible with LCH, a biopsy of the lesion is not obligatory. In all other cases a biopsy of the lesion is needed for inclusion into the study
  • Stratum VI

    -- Patients with newly diagnosed SS-LCH and localization other than "multifocal bone",isolated tumorous CNS lesion, or isolated "CNS-risk" lesion.

  • Stratum VII -- All patients registered in LCH IV (regardless of treatment) as long as consent for longterm follow-up has not been withheld.

Exclusion Criteria:

  • Stratum I

    • Pregnancy (patients of child-bearing age must be appropriately tested before chemotherapy)
    • LCH-related permanent consequences (e.g. vertebra plana, sclerosing cholangitis, lung fibrosis, etc.) in the absence of active disease
    • Prior systemic therapy
  • Stratum II

    • Patients with progressive disease in risk organs
    • Permanent consequences (e.g. sclerosing cholangitis, lung fibrosis, etc.) without evidence of active LCH in the same organ or in any other locations
    • No written consent of the patient or his/her parents or legal guardian
  • Stratum III

    • The presence of any of the following criteria will exclude the patient from the study:
    • Isolated sclerosing cholangitis without evidence of active hepatic LCH as the only evidence of risk organ involvement.
    • Inadequate renal function as defined by serum creatinine > 3x normal for age
  • Stratum IV

    • Pulmonary failure (requiring mechanical ventilation) not due to active LCH.
    • Isolated liver sclerosis or pulmonary fibrosis, without active LCH.
    • Uncontrolled active life-threatening infection.
    • Decreased renal function with a GFR of less than 50ml/1.73m2/min.
    • Pregnancy or active breast feeding
    • Failure to provide signed informed consent
  • Stratum VI

    • Patients with SS-LCH who have an isolated tumorous CNS lesion (they are eligible for Stratum V),
    • Patients with isolated "CNS-risk" or multifocal bone lesions (they are eligible for Stratum I, Group 2)

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Randomizowane
  • Model interwencyjny: Przydział równoległy
  • Maskowanie: Brak (otwarta etykieta)

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Eksperymentalny: Stratum I

Stratum I The combination of Prednisone and vinblastine is the standard first-line combination for patients needing systemic therapy (Stratum I). Patients with MS-LCH and involvement of risk organs, who do not respond to 6-12 weeks of standard therapy, will be immediately switched to alternative treatment approaches (Stratum III or Stratum IV).

Further therapy prolongation (12 vs. 24 months) and intensification (± mercaptopurine) will further reduce the reactivation rate and the permanent consequences.

Stratum I

Stratum I

Inne nazwy:
  • Velban®
  • Siarczan winkaleukoblastyny

Stratum I

Inne nazwy:
  • -Purinetol®
  • -6-MP
Eksperymentalny: Stratum II

A uniform "intensive" 24-week course consisting of prednisolone, vincristine and cytosine-arabinoside will be introduced in Stratum II for eligible patients. It will be followed by a continuation therapy to total treatment duration of 24 months. Participants who after SL-IT (week 24) have a response (NAD or AD better) are eligible for randomization between the continuation arms "INDOMETHACIN" and "6-MP/MTX" (mercaptopurine and Methotrexate).

Inne nazwy:
  • Cytarabina, Ara-C

Stratum I

Stratum I

Inne nazwy:
  • Velban®
  • Siarczan winkaleukoblastyny

Stratum I

Inne nazwy:
  • -Purinetol®
  • -6-MP

Indomethacin fixed dose given daily orally in two divided doses with gastric protection for total treatment duration of 24 months.

fixed dose weekly orally for total treatment duration of 24 months.

Eksperymentalny: Stratum III

Salvage treatment for risk LCH To assess the efficacy of the combination 2-CdA/Ara-C (Cytosine Arabinoside and 2-chlorodeoxyadenosine) in MS-LCH (patients with risk organ involvement, who fail to respond to front-line (Stratum I) therapy.

The initial therapy consists of 2 courses of 2-CdA/Ara-C. Continuation of outlined treatment to be assessed at assigned intervals in each stratum.

Inne nazwy:
  • Leustatyna®
  • 2-CdA
  • Kladrybina®
Eksperymentalny: Stratum IV

To determine the overall and disease free survival at 1 and 3 years after reduced intensity conditioning hematopoietic stem cell transplantation (RIC-HSCT). Salvage treatment option for MS-LCH patients with risk organ involvement, who fail to respond to front-line therapy (Stratum I) OR to the salvage 2- CdA/Ara-C regimen (Stratum III).

Eksperymentalny: Stratum V

Stratum V Monitoring and Treatment of isolated tumorous and neurodegenerative CNS-LCH

- Special regimens will be offered to patients with isolated tumorous CNS-LCH (repeated 2-CdA courses) and to patients with clinically manifested ND-CNS-LCH (+/- extracranial LCH manifestations). For the last group monotherapy with Ara-C courses or (Intravenous immunoglobulin)IVIG will be offered depending on physician's choice.

Inne nazwy:
  • Cytarabina, Ara-C
Inne nazwy:
  • Leustatyna®
  • 2-CdA
  • Kladrybina®
Inne nazwy:
  • IVIG
Eksperymentalny: Stratum VI

Natural history and management of "other" SS-LCH not eligible for stratum I group 2.

  • Treatment Options- Management (mostly "wait & see" and topical treatment) is left to the discretion of the treating physician. All treatments and disease responses must be reported in the database. In the case of uncertainties please contact your National Coordinator.
  • Patients being followed on Stratum VI who have progression of disease to MSLCH, multifocal bone disease or CNS-risk bone lesions should be enrolled on Stratum I therapy.
  • Patients being followed on Stratum VI who develop isolated tumorous or neurodegenerative CNS-LCH should be enrolled on Stratum V.
Inne nazwy:
  • Cytarabina, Ara-C
Inne nazwy:
  • Leustatyna®
  • 2-CdA
  • Kladrybina®
Inne nazwy:
  • IVIG

Stratum I

Stratum I

Inne nazwy:
  • Velban®
  • Siarczan winkaleukoblastyny

Stratum I

Inne nazwy:
  • -Purinetol®
  • -6-MP

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Percentage of Patients with Reactivation Free Survival
Ramy czasowe: 12 Months

Stratum I, II, VI

12 Months
Response Rate of Second Cycle
Ramy czasowe: 9 weeks

Stratum III

9 weeks
Overall and disease free survival at 1 and 3 years after reduced intensity conditioning hematopoietic stem cell transplantation (RIC-HSCT)
Ramy czasowe: 3 Years

Stratum IV

3 Years
The cumulative incidence of radiological and clinical neurodegeneration in patients with isolated tumorous CNS-LCH, DI, anterior pituitary dysfunction, and those with CNS-risk lesions
Ramy czasowe: 2 Years

Stratum V

2 Years
The time interval and cumulative incidence of progression of radiological neurodegeneration to clinically manifested ND-CNS-LCH
Ramy czasowe: 2 Years

Stratum V

2 Years
Cumulative incidence of specific Permanent Consequences e.g. diabetes insipidus (DI), growth hormone deficiency (GHD), neuropsychological impairment, etc.
Ramy czasowe: 2 Years

From all treatment stratum via long-term follow up in Stratum VII

2 Years

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
Liczba uczestników z poważnymi i niepoważnymi zdarzeniami niepożądanymi
Ramy czasowe: 2 lata
2 lata
Skumulowana częstość występowania reaktywacji w narządach ryzyka
Ramy czasowe: 2 lata
2 lata
Częstość występowania regeneracji hematopoetycznej i chimeryzmu dawcy w d + 100 i 1 rok po RIC-HSCT
Ramy czasowe: 2 lata
2 lata
Zidentyfikuj możliwe czynniki ryzyka trwałych konsekwencji (PC)
Ramy czasowe: 2 lata
2 lata
Overall Survival
Ramy czasowe: 2 Years

Stratum I

2 Years
Incidence of Permanent Consequences
Ramy czasowe: 2 Years

All Stratum

2 Years
Time to complete disease resolution
Ramy czasowe: 2 Years

Stratum III

2 Years
Response rate to the combination of prednisone, vincristine and cytarabine
Ramy czasowe: 2 years

Stratum II

2 years
The proportion of patients alive and free of disease without permanent consequences (e.g. diabetes insipidus, anterior pituitary dysfunction, radiological or clinical neurodegeneration)
Ramy czasowe: 2 Years

Stratum II

2 Years
Percentage of treatment-related toxicities
Ramy czasowe: 2 Years

Stratum II

2 Years
Reactivation rates after continuation treatment with Indomethacin vs. 6-MP/MTX.
Ramy czasowe: 2 years

Stratum II

2 years
The type of subsequent intensive and/or maintenance therapy utilized
Ramy czasowe: 2 Years

Stratum III

2 Years
Early and late mortality
Ramy czasowe: 2 Years

Stratum II

2 Years
Early and late toxicity
Ramy czasowe: 2 Years

Stratum III

2 Years
d+100 transplant related mortality
Ramy czasowe: 2 Years

Stratum IV

2 Years
Record all occurrence of skin, GI or liver abnormalities fulfilling criteria of Grades II-IV acute GVHD
Ramy czasowe: 2 Years

Stratum IV: Hematopoetic Stem Cell Transplantation for Risk LCH

2 Years
Percentage of Participants with incidence of chronic GVHD
Ramy czasowe: 2 Years

Stratum IV

2 Years
Response Rate to ND-CNS-targeted therapy at 12 and 24 months after start of therapy
Ramy czasowe: 2 years

Stratum V

2 years
Response of isolated tumorous CNS-LCH to 2-CDA
Ramy czasowe: 2 Years

Stratum V

2 Years
Frequency of ND-CNS-LCH in patients with isolated tumorous CNS-LCH
Ramy czasowe: 2 Years

Stratum V

2 Years
Methods of early identification of ND-CNS-LCH
Ramy czasowe: 2 Years

Stratum V - Exploration of the value of neurochemistry, neurophysiology, and neuropsychology methods in early identification of ND-CNS-LCH and in assessing its severity, and comparison to MRI findings.

2 Years
Need for systemic therapy later during disease course
Ramy czasowe: 2 Years

Stratum VI

2 Years

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

Współpracownicy

Śledczy

  • Krzesło do nauki: Milen Minkov, MD, Ph.D, Children's Cancer Research Institute / St. Anna Children's Hospital
  • Krzesło do nauki: Carlos Rodriguez-Galindo, MD, North American Consortium for Histiocytosis

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów

2 listopada 2016

Zakończenie podstawowe (Szacowany)

1 listopada 2031

Ukończenie studiów (Szacowany)

1 listopada 2031

Daty rejestracji na studia

Pierwszy przesłany

7 lipca 2014

Pierwszy przesłany, który spełnia kryteria kontroli jakości

30 lipca 2014

Pierwszy wysłany (Szacowany)

31 lipca 2014

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

10 listopada 2026

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

9 listopada 2026

Ostatnia weryfikacja

1 listopada 2026

Więcej informacji

Terminy związane z tym badaniem

Inne numery identyfikacyjne badania

  • 13-428
  • 2011-001699-20 (Numer EudraCT)
  • 042011 (Inny identyfikator: Children's Cancer Research Institute)

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .