My nephew (7 yrs old) was diagnosed Rosai Dorfman disease at the age of 1 yr. He has extranodal activity, which is generalized throughout the body. The disease has progressed rapidly in the last 2 years and has now revealed several areas in the right parietal and front areas of the skull with sclerosis of the bone, all of which vary in size. Nodes that are very enlarged have revealed themselves inside of the tracheal tube and are restricting his airway to 3 mm. He is currently on steroid therapy to reduce the swelling, which he is responding to. However, can you please tell me what alternatives are available for attacking this disease other than chemotherapy, which he has been on since his was initially diagnosed at the age of one and it is not working. Doctors are currently looking at doing a tracheostomy to provide airflow. There must be some other way to significantly reduce the swelling and spare an invasion of the trachea. Do you have any thoughts or insight on this?