Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center.
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.
Ghadjar
Pirus
P
Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
Joos
Daniela
D
Martinelli
Michele
M
Hullin
Roger
R
Zwahlen
Marcel
M
Lössl
Kristina
K
Carrel
Thierry
T
Aebersold
Daniel M
DM
Mohacsi
Paul
P
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000532:radiotherapy*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult