And more recently clofarabine, a new generation of deoxyadenosine analog, intermediate-dose methotrexate (100–175 mg/m2), thalidomide, tumor necrosis factor and its inhibitor, cyclosporine-A and stem cell transplantation all have been effective in the refractory/relapsed LCH, and organ transplantation is an effective therapy for end-stage liver and lung chronic fibrosis (sclerosing cholangitis) in the absence of active LCH. Here, TNF is linked to sclerosing cholangitis.