Total lymphoid irradiation

A novel and successful therapy for resistant cardiac allograft rejection

M. A. Evans, P. J. Schomberg, R. J. Rodeheffer, J. A. Katzmann, W. A. Schnell, H. D. Tazelaar, C. G A McGregor, Brooks Sayre Edwards

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Total lymphoid irradiation (TLI) is a novel type of adjuvant immunosuppression for patients who undergo cardiac transplantation and have refractory allograft rejection during standard immunosuppressive therapy. TLI consists of 6 to 10 fractions of 80 cGy (1 cGy = 1 rad) of irradiation to lymphatic tissues with use of the standard mantle and inverted Y fields. We have used TLI in six patients with biopsy-proven rejection that was refractory to standard treatments, including cyclosporine, azathioprine, antilymphocyte antibodies, and corticosteroids. In five patients, recalcitrant rejection was resolved after completion of TLI, and resolution persisted during long-term follow-up (17 to 30 months; mean, 22.2 months). In each patient, a substantial increase in the CD8 (suppressor T-lymphocyte) subset and elimination of B lymphocytes were demonstrated, findings that also persisted. Side effects were mild and primarily limited to transient leukopenia. In four patients, a readily treated cytomegalovirus reactivation was noted during TLI; thus, a causal relationship was suggested. In recipients of cardiac allografts who have refractory rejection, TLI provides long-lasting amelioration of the rejection profile. This result may be attributable to a relative enhancement of the suppressor T-cell subset and elimination of the B-lymphocyte line. Side effects are minimal, but monitoring for cytomegalovirus activation or reactivation is recommended.

Original languageEnglish (US)
Pages (from-to)785-790
Number of pages6
JournalMayo Clinic Proceedings
Volume67
Issue number8
StatePublished - 1992

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Lymphatic Irradiation
Allografts
T-Lymphocyte Subsets
Cytomegalovirus
B-Lymphocytes
Therapeutics
Antilymphocyte Serum
Azathioprine
Leukopenia
Lymphoid Tissue
Heart Transplantation
Immunosuppressive Agents
Immunosuppression
Cyclosporine
Adrenal Cortex Hormones
Biopsy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Evans, M. A., Schomberg, P. J., Rodeheffer, R. J., Katzmann, J. A., Schnell, W. A., Tazelaar, H. D., ... Edwards, B. S. (1992). Total lymphoid irradiation: A novel and successful therapy for resistant cardiac allograft rejection. Mayo Clinic Proceedings, 67(8), 785-790.

Total lymphoid irradiation : A novel and successful therapy for resistant cardiac allograft rejection. / Evans, M. A.; Schomberg, P. J.; Rodeheffer, R. J.; Katzmann, J. A.; Schnell, W. A.; Tazelaar, H. D.; McGregor, C. G A; Edwards, Brooks Sayre.

In: Mayo Clinic Proceedings, Vol. 67, No. 8, 1992, p. 785-790.

Research output: Contribution to journalArticle

Evans, MA, Schomberg, PJ, Rodeheffer, RJ, Katzmann, JA, Schnell, WA, Tazelaar, HD, McGregor, CGA & Edwards, BS 1992, 'Total lymphoid irradiation: A novel and successful therapy for resistant cardiac allograft rejection', Mayo Clinic Proceedings, vol. 67, no. 8, pp. 785-790.
Evans MA, Schomberg PJ, Rodeheffer RJ, Katzmann JA, Schnell WA, Tazelaar HD et al. Total lymphoid irradiation: A novel and successful therapy for resistant cardiac allograft rejection. Mayo Clinic Proceedings. 1992;67(8):785-790.
Evans, M. A. ; Schomberg, P. J. ; Rodeheffer, R. J. ; Katzmann, J. A. ; Schnell, W. A. ; Tazelaar, H. D. ; McGregor, C. G A ; Edwards, Brooks Sayre. / Total lymphoid irradiation : A novel and successful therapy for resistant cardiac allograft rejection. In: Mayo Clinic Proceedings. 1992 ; Vol. 67, No. 8. pp. 785-790.
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