Effect of total lymphoid irradiation on functional status in chronic multiple sclerosis: importance of lymphopenia early after treatment--the pros

Journal Article · Fri Jul 01 00:00:00 EDT 1988 · Neurology; (United States)

OSTI ID:7000588

Devereux, C; Troiano, R; Zito, G; Devereux, R B; Kopecky, K J; Friedman, R; Dowling, P C; Hafstein, M P; Rohowsky-Kochan, C; Cook, S D

To determine whether immunosuppression by total lymphoid irradiation (TLI) slowed deterioration of chronic progressive multiple sclerosis (MS), functional impairment score and blood lymphocyte counts were compared at 6-month intervals through 4 years following treatment of MS patients by either TLI (n = 27) or sham irradiation (n = 21). At each interval, 20 to 30% fewer TLI-treated patients had deteriorated (p less than 0.05 at 6, 12, and 18 months), and the difference in mean functional impairment score between groups became progressively greater (p less than 0.01 at 42 and 48 months). Benefit accrued principally to the 17 TLI-treated patients with absolute blood lymphocyte counts less than 900/mm3 3 months after treatment, whose mean functional impairment score remained within 0.6 units of baseline (p = NS), whereas the ten TLI patients with higher post-treatment lymphocyte counts had progressive deterioration (p less than 0.05 to p less than 0.001 versus TLI-treated patients with lower lymphocyte counts at all intervals except 30 months) and had deteriorated by more than 5 functional scale units by 42 and 48 months. Side effects were minor and complications rare in TLI-treated patients, but one TLI-treated patient developed staphylococcal sepsis. Thus, TLI slows deterioration of chronic progressive MS, with what appears to be enduring benefit through 4 years compartmented to patients with greater induced lymphopenia. Modification of lymphoid irradiation regimens to increase the proportion of MS patients who achieve a favorable degree of lymphopenia and to avert functional hyposplenism may further improve the benefit/risk ratio.

• Research Organization: Clara Maass Medical Center, Belleville, NJ (USA)
• OSTI ID: 7000588
• Journal Information: Neurology; (United States), Vol. 38
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
LYMPHATIC SYSTEM
IRRADIATION
LYMPHOCYTES
BLOOD COUNT
NERVOUS SYSTEM DISEASES
RADIOTHERAPY
IMMUNOSUPPRESSION
LEUKOPENIA
PATIENTS
ANIMAL CELLS
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY FLUIDS
CONNECTIVE TISSUE CELLS
DISEASES
HEMIC DISEASES
IMMUNE SYSTEM DISEASES
LEUKOCYTES
MATERIALS
MEDICINE
NUCLEAR MEDICINE
RADIOLOGY
SOMATIC CELLS
THERAPY
550603* - Medicine- External Radiation in Therapy- (1980-)