Skip to main content

Advertisement

Log in

Erdheim-Chester Disease: a Concise Review

  • Orphan Diseases (B Manger, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This report provides an overview of the current knowledge of molecular characterization, clinical description, and treatment of Erdheim-Chester disease (ECD), a multi-systemic adult histiocytosis of the L group.

Recent Findings

The recent identification of several MAPK mutations in histiocytes of ECD lesions. Leading to targeted therapies.

Summary

The discovery of the BRAFV600E mutation in ECD lesions followed by several other kinase mutations in the MAPK pathway has revolutionized our understanding of the disease pathogenesis and led to trials with targeted therapies that demonstrated robust efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Chester W. Über Lipoidgranulomatose. Virchows Arch Pathol Anat. 1930;279:561–602.

    Google Scholar 

  2. Haroche J, Charlotte F, Arnaud L, von Deimling A, Hélias-Rodzewicz Z, Hervier B, et al. High prevalence of BRAF V600E mutations in Erdheim-Chester disease but not in other non-Langerhans cell histiocytoses. Blood. 2012;120:2700–3.

    CAS  PubMed  Google Scholar 

  3. •• Diamond EL, Durham BH, Haroche J, Yao Z, Ma J, Parikh SA, et al. Diverse and targetable kinase alterations drive histiocytic neoplasms. Cancer Discov. 2016;6:154–65 This was the first study to combine whole exome and transcriptome sequencing of histiocytic neoplasm samples, which led to the discovery of previously unknown mutations.

    CAS  PubMed  Google Scholar 

  4. Emile J-F, Diamond EL, Hélias-Rodzewicz Z, Cohen-Aubart F, Charlotte F, Hyman DM, et al. Recurrent RAS and PIK3CA mutations in Erdheim-Chester disease. Blood. 2014;124:3016–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Haroche J, Cohen-Aubart F, Emile J-F, Arnaud L, Maksud P, Charlotte F, et al. Dramatic efficacy of vemurafenib in both multisystemic and refractory Erdheim-Chester disease and Langerhans cell histiocytosis harboring the BRAF V600E mutation. Blood. 2013;121:1495–500.

    CAS  PubMed  Google Scholar 

  6. Haroche J, Cohen-Aubart F, Emile J-F, Maksud P, Drier A, Tolédano D, et al. Reproducible and sustained efficacy of targeted therapy with vemurafenib in patients with BRAF(V600E)-mutated Erdheim-Chester disease. J Clin Oncol. 2015;33:411–8.

    CAS  PubMed  Google Scholar 

  7. • Cohen Aubart F, Emile J-F, Carrat F, Charlotte F, Benameur N, Donadieu J, et al. Targeted therapies in 54 patients with Erdheim-Chester disease, including follow-up after interruption (the LOVE study). Blood. 2017;130:1377–80 The results of this retrospective analysis of vemurafenib and/or cobimetinib efficacy in a large cohort of ECD patients demonstrated a high relapse rate after treatment interruption.

    PubMed  Google Scholar 

  8. Diamond EL, Durham BH, Ulaner GA, Drill E, Buthorn J, Ki M, et al. Efficacy of MEK inhibition in patients with histiocytic neoplasms. Nature. 2019;567:521–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Emile J-F, Abla O, Fraitag S, Horne A, Haroche J, Donadieu J, et al. Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages. Blood. 2016;127:2672–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Davies H, Bignell GR, Cox C, Stephens P, Edkins S, Clegg S, et al. Mutations of the BRAF gene in human cancer. Nature. 2002;417:949–54.

    CAS  PubMed  Google Scholar 

  11. Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto P, Larkin J, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364:2507–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Badalian-Very G, Vergilio J-A, Degar BA, MacConaill LE, Brandner B, Calicchio ML, et al. Recurrent BRAF mutations in Langerhans cell histiocytosis. Blood. 2010;116:1919–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Melloul S, Hélias-Rodzewicz Z, Cohen-Aubart F, Charlotte F, Fraitag S, Terrones N, et al. Highly sensitive methods are required to detect mutations in histiocytoses. Haematologica. 2019;104:e97–9.

    PubMed  PubMed Central  Google Scholar 

  14. Gianfreda D, Nicastro M, Galetti M, Alberici F, Corradi D, Becchi G, et al. Sirolimus plus prednisone for Erdheim-Chester disease: an open-label trial. Blood. 2015;126:1163–71.

    CAS  PubMed  Google Scholar 

  15. Durham BH, Lopez-Rodrigo E, Abramson DH, Picarsic J, Pastore A, Mandelker D, et al. Activating mutations in CSF1R and additional receptor tyrosine kinases in sporadic and familial histiocytic neoplasms. Blood. 2018;132:49.

    Google Scholar 

  16. Gomez Perdiguero E, Klapproth K, Schulz C, Busch K, Azzoni E, Crozet L, et al. Tissue-resident macrophages originate from yolk-sac-derived erythro-myeloid progenitors. Nature. 2015;518:547–51.

    PubMed  Google Scholar 

  17. • Durham BH, Roos-Weil D, Baillou C, Cohen-Aubart F, Yoshimi A, Miyara M, et al. Functional evidence for derivation of systemic histiocytic neoplasms from hematopoietic stem/progenitor cells. Blood. 2017;130:176–80 These authors were the first to find additional mutations usually seen in clonal hematopoiesis.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. • Milne P, Bigley V, Bacon CM, Néel A, McGovern N, Bomken S, et al. Hematopoietic origin of Langerhans cell histiocytosis and Erdheim-Chester disease in adults. Blood. 2017;130:167–75 These authors were the thirst to highlight the BRAF V600E mutation in myeloid progenitors and CD34+ cells from ECD patients.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Papo M, Diamond EL, Cohen-Aubart F, Emile J-F, Roos-Weil D, Gupta N, et al. High prevalence of myeloid neoplasms in adults with non-Langerhans cell histiocytosis. Blood. 2017;130:1007–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Haroche J, Poulain S, Marceau-Renaut A, Renneville A, Settegrana C, Maloum K, et al. Clonal hematopoiesis in Erdheim-Chester Disease. Blood. 2017;130:3788.

    Google Scholar 

  21. Haroche J, Amoura Z, Wechsler B, Veyssier-Belot C, Charlotte F, Piette J-C. Erdheim-Chester disease. Presse Med. 2007;36:1663–8.

    PubMed  Google Scholar 

  22. Stoppacciaro A, Ferrarini M, Salmaggi C, Colarossi C, Praderio L, Tresoldi M, et al. Immunohistochemical evidence of a cytokine and chemokine network in three patients with Erdheim-Chester disease: implications for pathogenesis. Arthritis Rheum. 2006;54:4018–22.

    CAS  PubMed  Google Scholar 

  23. Dagna L, Girlanda S, Langheim S, Rizzo N, Bozzolo EP, Sabbadini MG, et al. Erdheim-Chester disease: report on a case and new insights on its immunopathogenesis. Rheumatology (Oxford). 2010;49:1203–6.

    Google Scholar 

  24. Pacini G, Cavalli G, Tomelleri A, De Luca G, Pacini G, Ferrarini M, et al. The fibrogenic chemokine CCL18 is associated with disease severity in Erdheim-Chester disease. Oncoimmunology. 2018;7:e1440929 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993512/.

    PubMed  PubMed Central  Google Scholar 

  25. Arnaud L, Gorochov G, Charlotte F, Lvovschi V, Parizot C, Larsen M, et al. Systemic perturbation of cytokine and chemokine networks in Erdheim-Chester disease: a single-center series of 37 patients. Blood. 2011;117:2783–90.

    CAS  PubMed  Google Scholar 

  26. Michaloglou C, Vredeveld LCW, Soengas MS, Denoyelle C, Kuilman T, van der Horst CMAM, et al. BRAFE600-associated senescence-like cell cycle arrest of human naevi. Nature. 2005;436:720–4.

    CAS  PubMed  Google Scholar 

  27. Kriegl L, Neumann J, Vieth M, Greten FR, Reu S, Jung A, et al. Up and downregulation of p16(Ink4a) expression in BRAF-mutated polyps/adenomas indicates a senescence barrier in the serrated route to colon cancer. Mod Pathol. 2011;24:1015–22.

    CAS  PubMed  Google Scholar 

  28. Cangi MG, Biavasco R, Cavalli G, Grassini G, Dal-Cin E, Campochiaro C, et al. BRAFV600E-mutation is invariably present and associated to oncogene-induced senescence in Erdheim-Chester disease. Ann Rheum Dis. 2015;74:1596–602.

    CAS  PubMed  Google Scholar 

  29. Cohen-Aubart F, Emile J-F, Carrat F, Helias-Rodzewicz Z, Taly V, Charlotte F, et al. Phenotypes and survival in Erdheim-Chester disease: Results from a 165-patient cohort. Am J Hematol. 2018;93:E114–7.

    PubMed  Google Scholar 

  30. Estrada-Veras JI, O’Brien KJ, Boyd LC, Dave RH, Durham B, Xi L, et al. The clinical spectrum of Erdheim-Chester disease: an observational cohort study. Blood Adv. 2017;1:357–66.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Diamond EL, Dagna L, Hyman DM, Cavalli G, Janku F, Estrada-Veras J, et al. Consensus guidelines for the diagnosis and clinical management of Erdheim-Chester disease. Blood. 2014;124:483–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Tran T-A, Fabre M, Pariente D, Craiu I, Haroche J, Charlotte F, et al. Erdheim-Chester disease in childhood: a challenging diagnosis and treatment. J Pediatr Hematol Oncol. 2009;31:782–6.

    PubMed  Google Scholar 

  33. Kim S, Lee M, Shin HJ, Lee J, Suh Y-L. Coexistence of intracranial Langerhans cell histiocytosis and Erdheim-Chester disease in a pediatric patient: a case report. Childs Nerv Syst. 2016;32:893–6.

    PubMed  Google Scholar 

  34. Hao X, Feng R, Bi Y, Liu Y, Li C, Lu T, et al. Dramatic efficacy of dabrafenib in Erdheim-Chester disease (ECD): a pediatric patient with multiple large intracranial ECD lesions hidden by refractory Langerhans cell histiocytosis. J Neurosurg Pediatr. 2018;23:48–53.

    PubMed  Google Scholar 

  35. Haroche J, Amoura Z, Dion E, Wechsler B, Costedoat-Chalumeau N, Cacoub P, et al. Cardiovascular involvement, an overlooked feature of Erdheim-Chester disease: report of 6 new cases and a literature review. Medicine (Baltimore). 2004;83:371–92.

    Google Scholar 

  36. Chasset F, Barete S, Charlotte F, Cohen-Aubart F, Arnaud L, Le Pelletier F, et al. Cutaneous manifestations of Erdheim-Chester disease (ECD): clinical, pathological, and molecular features in a monocentric series of 40 patients. J Am Acad Dermatol. 2016;74:513–20.

    PubMed  Google Scholar 

  37. Arnaud L, Malek Z, Archambaud F, Kas A, Toledano D, Drier A, et al. 18F-fluorodeoxyglucose-positron emission tomography scanning is more useful in followup than in the initial assessment of patients with Erdheim-Chester disease. Arthritis Rheum. 2009;60:3128–38.

    PubMed  Google Scholar 

  38. Lachenal F, Cotton F, Desmurs-Clavel H, Haroche J, Taillia H, Magy N, et al. Neurological manifestations and neuroradiological presentation of Erdheim-Chester disease: report of 6 cases and systematic review of the literature. J Neurol. 2006;253:1267–77.

    PubMed  Google Scholar 

  39. Drier A, Haroche J, Savatovsky J, Godenèche G, Dormont D, Chiras J, et al. Cerebral, facial, and orbital involvement in Erdheim-Chester disease: CT and MR imaging findings. Radiology. 2010;255:586–94.

    PubMed  Google Scholar 

  40. Arnaud L, Hervier B, Néel A, Hamidou MA, Kahn J-E, Wechsler B, et al. CNS involvement and treatment with interferon-α are independent prognostic factors in Erdheim-Chester disease: a multicenter survival analysis of 53 patients. Blood. 2011;117:2778–82.

    CAS  PubMed  Google Scholar 

  41. Alper MG, Zimmerman LE, Piana FG. Orbital manifestations of Erdheim-Chester disease. Trans Am Ophthalmol Soc. 1983;81:64–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Cohen-Aubart F, Guerin M, Poupel L, Cluzel P, Saint-Charles F, Charlotte F, et al. Hypoalphalipoproteinemia and BRAFV600E mutation are major predictors of aortic infiltration in the Erdheim-Chester disease. Arterioscler Thromb Vasc Biol. 2018;38:1913–25.

    CAS  PubMed  Google Scholar 

  43. Courtillot C, Laugier Robiolle S, Cohen Aubart F, Leban M, Renard-Penna R, Drier A, et al. Endocrine manifestations in a monocentric cohort of 64 patients with Erdheim-Chester disease. J Clin Endocrinol Metab. 2016;101:305–13.

    CAS  PubMed  Google Scholar 

  44. Brun A-L, Touitou-Gottenberg D, Haroche J, Toledano D, Cluzel P, Beigelman-Aubry C, et al. Erdheim-Chester disease: CT findings of thoracic involvement. Eur Radiol. 2010;20:2579–87.

    PubMed  Google Scholar 

  45. Sheu S-Y, Wenzel RR, Kersting C, Merten R, Otterbach F, Schmid KW. Erdheim-Chester disease: case report with multisystemic manifestations including testes, thyroid, and lymph nodes, and a review of literature. J Clin Pathol. 2004;57:1225–8.

    PubMed  PubMed Central  Google Scholar 

  46. Guo S, Yan Q, Rohr J, Wang Y, Fan L, Wang Z. Erdheim-Chester disease involving the breast--a rare but important differential diagnosis. Hum Pathol. 2015;46:159–64.

    PubMed  Google Scholar 

  47. Arnaud L, Haroche J, Ghillani-Dalbin P, Piette JC, Musset L, Amoura Z. Le VEFG est élevé au cours de la maladie d’Erdheim-Chester : étude monocentrique de 24 patients. Rev Med Interne. 2009;30:60.

    Google Scholar 

  48. Legendre P, Norkowski E, Le Pelletier F, Miyara M, Choquet S, Haroche J, et al. Glomeruloid haemangioma: a possible consequence of elevated VEGF in POEMS and Erdheim-Chester disease. Eur J Dermatol. 2018;28:784–9.

    PubMed  Google Scholar 

  49. Diamond EL, Reiner AS, Buthorn JJ, Shuk E, Applebaum AJ, Hyman DM, et al. A scale for patient-reported symptom assessment for patients with Erdheim-Chester disease. Blood Adv. 2019;3:934–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Hervier B, Haroche J, Arnaud L, Charlotte F, Donadieu J, Néel A, et al. Association of both Langerhans cell histiocytosis and Erdheim-Chester disease linked to the BRAFV600E mutation. Blood. 2014;124:1119–26.

    CAS  PubMed  Google Scholar 

  51. Razanamahery J, Diamond EL, Cohen-Aubart F, Plate K-H, Lourida G, Charlotte F, et al. Erdheim-Chester disease with concomitant Rosai-Dorfman like lesions: a distinct entity mainly driven by MAP2K1. Haematologica. 2019.

  52. Roeser A, Cohen-Aubart F, Breillat P, Miyara M, Emile J-F, Charlotte F, et al. Autoimmunity associated with Erdheim-Chester disease improves with BRAF/MEK inhibitors. Haematologica. 2019;2019:haematol.2018.214007.

    Google Scholar 

  53. Hyman DM, Puzanov I, Subbiah V, Faris JE, Chau I, Blay J-Y, et al. Vemurafenib in multiple nonmelanoma cancers with BRAF V600 mutations. N Engl J Med. 2015;373:726–36.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Diamond EL, Subbiah V, Lockhart AC, Blay J-Y, Puzanov I, Chau I, et al. Vemurafenib for BRAF V600-mutant Erdheim-Chester disease and Langerhans cell histiocytosis: analysis of data from the histology-independent, phase 2, open-label VE-BASKET study. JAMA Oncol. 2018;4:384–8.

    PubMed  Google Scholar 

  55. Cohen-Aubart F, Maksud P, Saadoun D, Drier A, Charlotte F, Cluzel P, et al. Variability in the efficacy of the IL1 receptor antagonist anakinra for treating Erdheim-Chester disease. Blood. 2016;127:1509–12.

    CAS  PubMed  Google Scholar 

  56. Goyal G, Shah MV, Call TG, Litzow MR, Wolanskyj-Spinner AP, Koster MJ, et al. Efficacy of biological agents in the treatment of Erdheim-Chester disease. Br J Haematol. 2018;183:520–4.

    PubMed  Google Scholar 

  57. Cohen-Aubart F, Maksud P, Emile J-F, Benameur N, Charlotte F, Cluzel P, et al. Efficacy of infliximab in the treatment of Erdheim-Chester disease. Ann Rheum Dis. 2018;77:1387–90.

    CAS  PubMed  Google Scholar 

  58. Berti A, Cavalli G, Guglielmi B, Biavasco R, Campochiaro C, Tomelleri A, et al. Tocilizumab in patients with multisystem Erdheim-Chester disease. Oncoimmunology. 2017;6:e1318237.

    PubMed  PubMed Central  Google Scholar 

  59. Goyal G, Shah MV, Call TG, Litzow MR, Hogan WJ, Go RS. Clinical and radiologic responses to cladribine for the treatment of Erdheim-Chester disease. JAMA Oncol. 2017;3:1253–6.

    PubMed  PubMed Central  Google Scholar 

  60. Franconieri F, Martin-Silva N, de Boysson H, Galateau-Salle F, Emile J-F, Bienvenu B, et al. Superior efficacy and tolerance of reduced doses of vemurafenib plus anakinra in Erdheim-Chester disease: towards the paradigm of combined targeting and immune therapies. Acta Oncol. 2016;55:930–2.

    PubMed  Google Scholar 

  61. Donadieu J, Bernard F, van Noesel M, Barkaoui M, Bardet O, Mura R, et al. Cladribine and cytarabine in refractory multisystem Langerhans cell histiocytosis: results of an international phase 2 study. Blood. 2015;126:1415–23.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julien Haroche.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the tropical collection on Orphan Diseases.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Papo, M., Emile, JF., Maciel, T.T. et al. Erdheim-Chester Disease: a Concise Review. Curr Rheumatol Rep 21, 66 (2019). https://doi.org/10.1007/s11926-019-0865-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-019-0865-2

Keywords

Navigation