Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center.
- Ghadjar P Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
- Joos D
- Martinelli M
- Hullin R
- Zwahlen M
- Lössl K
- Carrel T
- Aebersold DM
- Mohacsi P
- 2010-01-19
Published in:
- Radiation oncology (London, England). - 2010
Adult
Female
Follow-Up Studies
Graft Rejection
Heart Transplantation
Humans
Lymphatic Irradiation
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Young Adult
English
BACKGROUND
To assess safety and efficacy of tailored total lymphoid irradiation (tTLI) in cardiac transplant patients.
METHODS
A total of seven patients, of which five had recalcitrant cellular cardiac allograft rejection (RCCAR), confirmed by endomyocardial biopsies, and two had side effects of immunosuppressive drug therapy, were all treated with tTLI. tTLI was defined by the adjustment of both the fraction interval and the final irradiation dosage both being dependent on the patients general condition, irradiation-dependent response, and the white blood and platelet counts. A mean dose of 6.4 Gy (range, 1.6 - 8.8 Gy) was given. Median follow-up was 7 years (range, 1.8 - 12.2 years).
RESULTS
tTLI was well tolerated. Two patients experienced a severe infection during tTLI (pneumocystis jirovecii pneumonia, urosepsis and generalized herpes zoster) and one patient developed a lymphoproliferative disorder after tTLI. The rate of rejection episodes before tTLI was 0.43 episodes/patient/month and decreased to 0.02 episodes/patient/month after tTLI (P < .001). At the end of the observation time, all patients except one were alive.
CONCLUSIONS
tTLI is a useful treatment strategy for the management of RCCAR and in patients with significant side effects of immunosuppressive drug therapy. In this series tTLI demonstrated significantly decreased rejection rates without causing relevant treatment-related toxicity.
To assess safety and efficacy of tailored total lymphoid irradiation (tTLI) in cardiac transplant patients.
METHODS
A total of seven patients, of which five had recalcitrant cellular cardiac allograft rejection (RCCAR), confirmed by endomyocardial biopsies, and two had side effects of immunosuppressive drug therapy, were all treated with tTLI. tTLI was defined by the adjustment of both the fraction interval and the final irradiation dosage both being dependent on the patients general condition, irradiation-dependent response, and the white blood and platelet counts. A mean dose of 6.4 Gy (range, 1.6 - 8.8 Gy) was given. Median follow-up was 7 years (range, 1.8 - 12.2 years).
RESULTS
tTLI was well tolerated. Two patients experienced a severe infection during tTLI (pneumocystis jirovecii pneumonia, urosepsis and generalized herpes zoster) and one patient developed a lymphoproliferative disorder after tTLI. The rate of rejection episodes before tTLI was 0.43 episodes/patient/month and decreased to 0.02 episodes/patient/month after tTLI (P < .001). At the end of the observation time, all patients except one were alive.
CONCLUSIONS
tTLI is a useful treatment strategy for the management of RCCAR and in patients with significant side effects of immunosuppressive drug therapy. In this series tTLI demonstrated significantly decreased rejection rates without causing relevant treatment-related toxicity.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/1748-717X-5-3
- PMID 20078889
- Persistent URL
- https://sonar.ch/global/documents/101714
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