Combination total lymphoid irradiation and low-dose corticosteroid therapy for progressive multiple sclerosis.
Total lymphoid irradiation (TLI) has been reported to delay deterioration in patients with progressive multiple sclerosis and other autoimmune disorders. METHODS--In an open trial, the effect of TLI combined with a one year course of low dose prednisone was compared to the effect of sham TLI and TLI only in a prior double-blind study of patients with progressive multiple sclerosis. RESULTS--Twenty-seven patients receiving TLI combined with corticosteroids had significantly greater lymphocytopenia in the year post-therapy than those receiving TLI only or sham TLI and Kaplan Meier product-limit survival analysis showed significantly less progression in the TLI plus steroid group over 4 years of follow-up. No difference in lymphocytopenia or progression was found with TLI plus corticosteroid therapy when the spleen was removed from the field of irradiation. CONCLUSION--These results lend further support to the hypothesis that TLI may be effective in progressive MS, and indicates that adding low-dose prednisone may enhance this effect. The study also suggests that TLI may be equally effective whether or not the spleen is irradiated.
Cook
S D
SD
Department of Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, USA.
Devereux
C
C
Troiano
R
R
Bansil
S
S
Zito
G
G
Sheffet
A
A
Jotkowitz
A
A
Rohowsky-Kochan
C
C
Dowling
P C
PC
D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects*; D018655:Lymphocyte Count / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000532:radiotherapy*; D011241:Prednisone / Q000008:administration & dosage* / Q000627:therapeutic use*; D016896:Treatment Outcome
D011241:Prednisone