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Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center

Identifieur interne : 000468 ( Pmc/Curation ); précédent : 000467; suivant : 000469

Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center

Auteurs : Pirus Ghadjar [Suisse] ; Daniela Joos [Suisse] ; Michele Martinelli [Suisse] ; Roger Hullin [Suisse] ; Marcel Zwahlen [Suisse] ; Kristina Lössl [Suisse] ; Thierry Carrel [Suisse] ; Daniel M. Aebersold [Suisse] ; Paul Mohacsi [Suisse]

Source :

RBID : PMC:2822786

Abstract

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.


Url:
DOI: 10.1186/1748-717X-5-3
PubMed: 20078889
PubMed Central: 2822786

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PMC:2822786

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<title>Background</title>
<p>To assess safety and efficacy of tailored total lymphoid irradiation (tTLI) in cardiac transplant patients.</p>
</sec>
<sec>
<title>Methods</title>
<p>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).</p>
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<p>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.</p>
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<title>Conclusions</title>
<p>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.</p>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Radiat Oncol</journal-id>
<journal-title-group>
<journal-title>Radiation Oncology (London, England)</journal-title>
</journal-title-group>
<issn pub-type="epub">1748-717X</issn>
<publisher>
<publisher-name>BioMed Central</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">20078889</article-id>
<article-id pub-id-type="pmc">2822786</article-id>
<article-id pub-id-type="publisher-id">1748-717X-5-3</article-id>
<article-id pub-id-type="doi">10.1186/1748-717X-5-3</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" id="A1">
<name>
<surname>Ghadjar</surname>
<given-names>Pirus</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<email>pirus@gmx.de</email>
</contrib>
<contrib contrib-type="author" id="A2">
<name>
<surname>Joos</surname>
<given-names>Daniela</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<email>daniela.joos@insel.ch</email>
</contrib>
<contrib contrib-type="author" id="A3">
<name>
<surname>Martinelli</surname>
<given-names>Michele</given-names>
</name>
<xref ref-type="aff" rid="I2">2</xref>
<email>michele.martinelli@insel.ch</email>
</contrib>
<contrib contrib-type="author" id="A4">
<name>
<surname>Hullin</surname>
<given-names>Roger</given-names>
</name>
<xref ref-type="aff" rid="I2">2</xref>
<email>roger.hullin@insel.ch</email>
</contrib>
<contrib contrib-type="author" id="A5">
<name>
<surname>Zwahlen</surname>
<given-names>Marcel</given-names>
</name>
<xref ref-type="aff" rid="I3">3</xref>
<email>Zwahlen@ispm.unibe.ch</email>
</contrib>
<contrib contrib-type="author" id="A6">
<name>
<surname>Lössl</surname>
<given-names>Kristina</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<email>kristina.loessl@insel.ch</email>
</contrib>
<contrib contrib-type="author" id="A7">
<name>
<surname>Carrel</surname>
<given-names>Thierry</given-names>
</name>
<xref ref-type="aff" rid="I2">2</xref>
<email>Thierry.carrel@insel.ch</email>
</contrib>
<contrib contrib-type="author" id="A8">
<name>
<surname>Aebersold</surname>
<given-names>Daniel M</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<email>daniel.aebersold@insel.ch</email>
</contrib>
<contrib contrib-type="author" corresp="yes" id="A9">
<name>
<surname>Mohacsi</surname>
<given-names>Paul</given-names>
</name>
<xref ref-type="aff" rid="I2">2</xref>
<email>Paul.mohacsi@insel.ch</email>
</contrib>
</contrib-group>
<aff id="I1">
<label>1</label>
Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</aff>
<aff id="I2">
<label>2</label>
Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</aff>
<aff id="I3">
<label>3</label>
Institute of Social and Preventive Medicine, University of Bern, Switzerland, Finkenhubelweg 11, 3012 Bern, Switzerland</aff>
<pub-date pub-type="collection">
<year>2010</year>
</pub-date>
<pub-date pub-type="epub">
<day>16</day>
<month>1</month>
<year>2010</year>
</pub-date>
<volume>5</volume>
<fpage>3</fpage>
<lpage>3</lpage>
<history>
<date date-type="received">
<day>7</day>
<month>8</month>
<year>2009</year>
</date>
<date date-type="accepted">
<day>16</day>
<month>1</month>
<year>2010</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright ©2010 Ghadjar et al; licensee BioMed Central Ltd.</copyright-statement>
<copyright-year>2010</copyright-year>
<copyright-holder>Ghadjar et al; licensee BioMed Central Ltd.</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0">
<license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<self-uri xlink:href="http://www.ro-journal.com/content/5/1/3"></self-uri>
<abstract>
<sec>
<title>Background</title>
<p>To assess safety and efficacy of tailored total lymphoid irradiation (tTLI) in cardiac transplant patients.</p>
</sec>
<sec>
<title>Methods</title>
<p>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).</p>
</sec>
<sec>
<title>Results</title>
<p>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.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>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.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
</record>

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