TY - JOUR
T1 - Efficacy and safety of total lymphoid irradiation in different chronic lung allograft dysfunction phenotypes
AU - Geng-Cahuayme, Abraham André Arturo
AU - Sáez-Giménez, Berta
AU - Altabas-González, Manuel
AU - Vázquez-Varela, Miriam
AU - Berastegui-Garcia, Cristina
AU - Giralt-López de Sagredo, Jordi
AU - Zapata-Ortega, Marta
AU - Recalde-Vizcay, Enar
AU - López-Meseguer, Manuel
N1 - © 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2023/2
Y1 - 2023/2
N2 - Total lymphoid irradiation (TLI) is an alternative treatment for chronic lung allograft dysfunction (CLAD). However, data regarding its efficacy and tolerance are scarce. This study included patients with CLAD treated with TLI at our center between 2011 and 2018. Clinical characteristics before and after TLI and related complications were analyzed. Forty patients with CLAD (twenty-nine bronchiolitis obliterans syndrome [BOS], nine restrictive allograft syndrome [RAS], and two mixed) were included. Significant attenuation of the forced expiratory volume in 1-sec (FEV1 ) decline slope was observed in all phenotypes, in both the BOS and RAS. The median FEV1 12, 6, and 3 months pre-TLI were as follows: 1980 (IQR 1720-2560), 1665 (IQR 1300-2340) and 1300 (IQR 1040-1740) ml (p < .001), while the median FEV1 at 3, 6, and 12 months post-TLI was 1110 (IQR 810-1440), 1130 (IQR 860-1470), and 1115 (IQR 865-1490) ml (p = .769). No dropouts due to radiation toxicity were observed. The mean survival according to the Karnofsky Performance Status Scale (KPS) >70 or ≤70 at baseline was 1837 (IQR 259-2522) versus 298 (IQR 128-554) days (p < .0001), respectively. In conclusion, TLI may stop FEV1 decline in both BOS and RAS. Moreover, a good KPS score may be an important prognostic factor.
AB - Total lymphoid irradiation (TLI) is an alternative treatment for chronic lung allograft dysfunction (CLAD). However, data regarding its efficacy and tolerance are scarce. This study included patients with CLAD treated with TLI at our center between 2011 and 2018. Clinical characteristics before and after TLI and related complications were analyzed. Forty patients with CLAD (twenty-nine bronchiolitis obliterans syndrome [BOS], nine restrictive allograft syndrome [RAS], and two mixed) were included. Significant attenuation of the forced expiratory volume in 1-sec (FEV1 ) decline slope was observed in all phenotypes, in both the BOS and RAS. The median FEV1 12, 6, and 3 months pre-TLI were as follows: 1980 (IQR 1720-2560), 1665 (IQR 1300-2340) and 1300 (IQR 1040-1740) ml (p < .001), while the median FEV1 at 3, 6, and 12 months post-TLI was 1110 (IQR 810-1440), 1130 (IQR 860-1470), and 1115 (IQR 865-1490) ml (p = .769). No dropouts due to radiation toxicity were observed. The mean survival according to the Karnofsky Performance Status Scale (KPS) >70 or ≤70 at baseline was 1837 (IQR 259-2522) versus 298 (IQR 128-554) days (p < .0001), respectively. In conclusion, TLI may stop FEV1 decline in both BOS and RAS. Moreover, a good KPS score may be an important prognostic factor.
KW - Allografts
KW - Immunology
KW - Lung transplantation
KW - Organ transplantation
KW - Radiotherapy
KW - Allografts
KW - Immunology
KW - Lung transplantation
KW - Organ transplantation
KW - Radiotherapy
KW - Allografts
KW - Immunology
KW - Lung transplantation
KW - Organ transplantation
KW - Radiotherapy
U2 - 10.1111/ctr.14891
DO - 10.1111/ctr.14891
M3 - Article
C2 - 36583252
SN - 0902-0063
VL - 37
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 2
M1 - e14891
ER -