Beyond cancer treatment – a review of total lymphoid irradiation for heart and lung transplant recipients

Abstract

Immunosuppressive drugs used in the management of heart and lung transplants have a large monetary and quality of life cost due to their side effects. Total lymphoid irradiation (TLI) is one method of minimising the need for or replacing post-operative immunosuppressive drugs. A literature review was conducted on electronic databases using defined search terms. The aim was to establish the indications for the use of TLI, its advantages and disadvantages and the weaknesses associated with the methods used in related research. Eight articles were located that focused on TLI usage in combating organ rejection. These studies identified that the use of TLI resulted in a reduction in early rejection. One study reported a drop in rejection episodes from 0.46 to 0.14 episodes per patient per month once the TLI was complete. While the short-term prognosis is excellent, the long-term outlook is less positive with an increased risk of organ rejection and myelodysplasia 3.5 years post-TLI. This review reminds us that radiation therapy (RT) is not exclusively indicated for cancer treatment. While TLI cannot replace immunosuppressive drug therapy, it can offer a treatment option for people that cannot tolerate immunosuppressive drugs, or when conventional anti-rejection treatment is no longer viable. Reported long-term complications suggest that TLI should be used with caution. However, this modality should not be overlooked in cases of chronic rejection. Further research is required to establish the efficacy of RT in the treatment of transplant patients who are unsuitable for drug-based anti-rejection therapies.

Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation: a single‐center experience and review of literature

“…TLI was first used to treat Hodgkin’s disease and is nowadays still used in the context of nonmyeloablative conditioning prior to allogeneic HSCT . In the 80s and 90s, TLI emerged as treatment for cardiac and renal allograft rejection . Yet, because of concerns about long‐term radiation‐related side effects, such as myelodysplasia and leukemia, and because newer immunosuppressive treatments became available, TLI was reserved as ultimate salvage therapy in this setting.…”

“…Long‐term complications of TLI in adults are mostly limited in severity and asymptomatic . Nevertheless, delayed TLI treatment because of abnormal blood count (65%) and infections (20%) was reported in a significant proportion of BOS patients .…”

“…Total lymphoid irradiation (TLI) has been successfully used in the past as immunosuppressive salvage treatment in renal, cardiac, and lung allograft rejection . Nevertheless, only limited experience of TLI in CLAD, exclusively for progressive BOS, has been reported to date.…”

Tumor necrosis factor‑related apoptosis‑inducing ligand additive with Iodine‑131 of inhibits non‑small cell lung cancer cells through promoting apoptosis

“…At present, a number of clinical therapeutic methods have been explored and applied for the treatments of patients with NSCLC, including radiotherapy, chemotherapy, Chinese medicinal herb treatment, immunotherapy, genetic and targeted therapies ( 5 , 6 ). However, the overall 5-year survival has remained poor, at <15% in patients with NSCLC in developing countries since 2008 ( 7 – 9 ).…”

Safety and efficacy of a nonmyeloablative pretransplant conditioning regimen using total lymphoid irradiation with volumetric modulated arc therapy in healthy dogs: A pilot study

“…These conditioning treatments are used according to disease, stage or patient conditions (Lebeer et al., 2020; Schultheiss et al., 2007). TLI is one of the nonmyeloablative conditioning techniques in allogeneic hematopoietic cell or organ transplantation in human patients (McKay et al., 2014; Spinner et al., 2019). The main objective of TLI is to induce sufficient immunosuppression to prevent graft rejection.…”