title: Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center.
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.
authors.affiliation: Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Pirus
authors.initials: P
authors.lastname: Ghadjar
authors.forename: Daniela
authors.initials: D
authors.lastname: Joos
authors.forename: Michele
authors.initials: M
authors.lastname: Martinelli
authors.forename: Roger
authors.initials: R
authors.lastname: Hullin
authors.forename: Marcel
authors.initials: M
authors.lastname: Zwahlen
authors.forename: Kristina
authors.initials: K
authors.lastname: Lössl
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Aebersold
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
mesh_terms: 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