title: Total nodal irradiation in patients with severe treatment-refractory chronic graft-versus-host disease after allogeneic stem cell transplantation: Response rates and immunomodulatory effects.
abstract: OBJECTIVE
  The use of total nodal irradiation (TNI) has been reported as an immunomodulatory therapy for different diseases including chronic graft-versus-host disease (cGVHD).
  
  
  METHODS
  We retrospectively analyzed 13 patients with treatment-refractory cGVHD receiving TNI with 1×1Gy from 2001 to 2014. In 10 of 13 patients immunomodulatory effects of TNI were measured.
  
  
  RESULTS
  At time of TNI all patients had severe cGVHD (involving the skin: n=12), fascia (n=6), oral mucosa (n=8), eye (n=8), and lung (n=5). Nine of 13 patients had corticosteroid-refractory cGVHD. In 7 of 13 patients (54%) a partial response (PR) could be achieved. In 3 patients (23%) cGVHD manifestations remained stable, 2 patients progressed. One patient was not evaluable due to follow-up <1 month. At 3 months after TNI, best responses could be achieved in skin, and oral involvement including steroid sparing activity. TNI was well tolerated with adverse effects limited to reversible thrombocytopenia and neutropenia. Immunomodulatory effects on peripheral blood cells could be demonstrated including an increase of CD4+ T cells in the group of responders.
  
  
  CONCLUSIONS
  TNI represents an effective immunomodulating therapy in treatment-refractory cGVHD.
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany. Electronic address: anke.hautmann@ukr.de.
authors.forename: Anke H
authors.initials: AH
authors.lastname: Hautmann
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wolff
authors.affiliation: Department of Internal Medicine (Hematology and Oncology), University Hospital of Rostock, Germany.
authors.forename: Inken
authors.initials: I
authors.lastname: Hilgendorf
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Fehn
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Edinger
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Hoffmann
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herr
authors.affiliation: Department of Radiotherapy, University Medical Center of Regensburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kölbl
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Holler
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Sporrer
authors.affiliation: Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Holler
authors.affiliation: Department of Radiotherapy, University Medical Center of Regensburg, Germany.
authors.forename: Matthias G
authors.initials: MG
authors.lastname: Hautmann
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000532:radiotherapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous
keywords: Chronic graft-versus-host disease (GVHD); Corticosteroid-refractory chronic GVHD; Hematopoietic stem cell transplantation; Immunomodulatory therapy; Total lymphoid irradiation; Total nodal irradiation