Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center
Identifieur interne : 000562 ( Main/Exploration ); précédent : 000561; suivant : 000563Tailored 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 :
- Radiation Oncology (London, England) [ 1748-717X ] ; 2010.
Abstract
To assess safety and efficacy of tailored total lymphoid irradiation (tTLI) in cardiac transplant patients.
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).
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.
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
Affiliations:
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Berne</region></placeName></affiliation></author><author><name sortKey="Joos, Daniela" sort="Joos, Daniela" uniqKey="Joos D" first="Daniela" last="Joos">Daniela Joos</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Martinelli, Michele" sort="Martinelli, Michele" uniqKey="Martinelli M" first="Michele" last="Martinelli">Michele Martinelli</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Hullin, Roger" sort="Hullin, Roger" uniqKey="Hullin R" first="Roger" last="Hullin">Roger Hullin</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Zwahlen, Marcel" sort="Zwahlen, Marcel" uniqKey="Zwahlen M" first="Marcel" last="Zwahlen">Marcel Zwahlen</name><affiliation wicri:level="4"><nlm:aff id="I3">Institute of Social and Preventive Medicine, University of Bern, Switzerland, Finkenhubelweg 11, 3012 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Institute of Social and Preventive Medicine, University of Bern, Switzerland, Finkenhubelweg 11, 3012 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName><orgName type="university">Université de Berne</orgName><placeName><settlement type="city">Berne</settlement><region nuts="3" type="region">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Lossl, Kristina" sort="Lossl, Kristina" uniqKey="Lossl K" first="Kristina" last="Lössl">Kristina Lössl</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Carrel, Thierry" sort="Carrel, Thierry" uniqKey="Carrel T" first="Thierry" last="Carrel">Thierry Carrel</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Aebersold, Daniel M" sort="Aebersold, Daniel M" uniqKey="Aebersold D" first="Daniel M" last="Aebersold">Daniel M. Aebersold</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Mohacsi, Paul" sort="Mohacsi, Paul" uniqKey="Mohacsi P" first="Paul" last="Mohacsi">Paul Mohacsi</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Bern, Freiburgstrasse, 3010 Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author></analytic><series><title level="j">Radiation Oncology (London, England)</title><idno type="eISSN">1748-717X</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><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. 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sortKey="O Sullivan, Ej" uniqKey="O Sullivan E">EJ O'Sullivan</name></author><author><name sortKey="Hubbell, Ea" uniqKey="Hubbell E">EA Hubbell</name></author><author><name sortKey="Zucker, Mj" uniqKey="Zucker M">MJ Zucker</name></author><author><name sortKey="Pifarre, R" uniqKey="Pifarre R">R Pifarre</name></author><author><name sortKey="Mcmanus, Bm" uniqKey="Mcmanus B">BM McManus</name></author><author><name sortKey="Winters, Gl" uniqKey="Winters G">GL Winters</name></author><author><name sortKey="Scanlon, Pj" uniqKey="Scanlon P">PJ Scanlon</name></author><author><name sortKey="Robinson, Ja" uniqKey="Robinson J">JA Robinson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bourge, Rc" uniqKey="Bourge R">RC Bourge</name></author><author><name sortKey="Kirklin, Jk" uniqKey="Kirklin J">JK Kirklin</name></author><author><name sortKey="Mcgriffin, Dc" uniqKey="Mcgriffin D">DC McGriffin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Kw" uniqKey="Kim K">KW Kim</name></author><author><name sortKey="Hwang, M" uniqKey="Hwang M">M Hwang</name></author><author><name sortKey="Moretti, L" uniqKey="Moretti L">L Moretti</name></author><author><name sortKey="Jaboin, Jj" uniqKey="Jaboin J">JJ Jaboin</name></author><author><name sortKey="Cha, Yi" uniqKey="Cha Y">YI Cha</name></author><author><name sortKey="Lu, B" uniqKey="Lu B">B Lu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Murphy, Jd" uniqKey="Murphy J">JD Murphy</name></author><author><name sortKey="Spalding, Ac" uniqKey="Spalding A">AC Spalding</name></author><author><name sortKey="Somnay, Yr" uniqKey="Somnay Y">YR Somnay</name></author><author><name sortKey="Markwart, S" uniqKey="Markwart S">S Markwart</name></author><author><name sortKey="Ray, Me" uniqKey="Ray M">ME Ray</name></author><author><name sortKey="Hamstra, Da" uniqKey="Hamstra D">DA Hamstra</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Suisse</li></country><region><li>Canton de Berne</li></region><settlement><li>Berne</li></settlement><orgName><li>Université de Berne</li></orgName></list><tree><country name="Suisse"><region name="Canton de Berne"><name sortKey="Ghadjar, Pirus" sort="Ghadjar, Pirus" uniqKey="Ghadjar P" first="Pirus" last="Ghadjar">Pirus Ghadjar</name></region><name sortKey="Aebersold, Daniel M" sort="Aebersold, Daniel M" uniqKey="Aebersold D" first="Daniel M" last="Aebersold">Daniel M. Aebersold</name><name sortKey="Carrel, Thierry" sort="Carrel, Thierry" uniqKey="Carrel T" first="Thierry" last="Carrel">Thierry Carrel</name><name sortKey="Hullin, Roger" sort="Hullin, Roger" uniqKey="Hullin R" first="Roger" last="Hullin">Roger Hullin</name><name sortKey="Joos, Daniela" sort="Joos, Daniela" uniqKey="Joos D" first="Daniela" last="Joos">Daniela Joos</name><name sortKey="Lossl, Kristina" sort="Lossl, Kristina" uniqKey="Lossl K" first="Kristina" last="Lössl">Kristina Lössl</name><name sortKey="Martinelli, Michele" sort="Martinelli, Michele" uniqKey="Martinelli M" first="Michele" last="Martinelli">Michele Martinelli</name><name sortKey="Mohacsi, Paul" sort="Mohacsi, Paul" uniqKey="Mohacsi P" first="Paul" last="Mohacsi">Paul Mohacsi</name><name sortKey="Zwahlen, Marcel" sort="Zwahlen, Marcel" uniqKey="Zwahlen M" first="Marcel" last="Zwahlen">Marcel Zwahlen</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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