Effect of Total Lymphoid Irradiation in Chronic Progressive Multiple Sclerosis

Cook, StuartD.; Troiano, Raymond; Zito, George; Lavenhar, Marvin A.; Devereux, C.; Hafstein, MarinosP.; Hernández, Elkin; Vidaver, Robert M.; Dowling, Peter C.

doi:10.1016/s0140-6736(86)91554-0

Cited by 90 publications

(23 citation statements)

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“…The temporary bone marrow suppression that terminated radiation treatments in 2 patients in the original study (2) was not encountered in this trial. Fewer complications have occurred in patients at other centers, where 2,000-cGy, 2-portal TLI was used for RA (1,3,7), systemic lupus erythematosus (20), and multiple sclerosis (21). It is, however, likely that 2,000 cGy, as well as the higher dose, heightened our patients' susceptibility to herpes zoster.…”

Section: Discussionmentioning

confidence: 88%

2,000‐Centigray total lymphoid irradiation for refractory rheumatoid arthritis

Trentham

Belli

Bloomer

et al. 1987

Arthritis & Rheumatism

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Because toxicity with the use of 3,000 centiGray (cGy) of total lymphoid irradiation (TLI) was observed in an earlier study, 2,000‐cGy treatments were delivered in a 2‐portal format to 7 patients and in a modified 3‐portal fashion to 6 patients, as part of a randomized, investigator‐blinded trial of TLI treatment for refractory rheumatoid arthritis. Analysis of combined data from the 13 patients revealed statistically significant improvement in 5 clinical indicators of disease activity at the end of TLI and 6 and 12 months later, accompanied by T4‐specific immunosuppression. Management considerations resulted in the introduction of prednisone therapy in 5 patients, methotrexate in 4, and azathioprine in 1 during the interval of 8–12 months post‐TLI. Herpes zoster occurred in 5 patients prior to the initiation of this additional therapy. These data indicate that, in patients with rheumatoid arthritis, a TLI dose of 2,000 cGy is sufficient to produce measurable benefit that lasts for 6 months, and that the improvement can be maintained at 12 months by the use of prednisone and methotrexate.

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Section: Discussionmentioning

confidence: 88%

2,000‐Centigray total lymphoid irradiation for refractory rheumatoid arthritis

Trentham

Belli

Bloomer

et al. 1987

Arthritis & Rheumatism

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“…Craniospinal irradiation has been tested as therapy for MS patients and was not found to be beneficial. [34][35][36][37][38][39][40][41][42] Tumoricidal doses of cranial radiation (Ͼ 4000 cGy) have been reported to be associated with both progression and exacerbation of MS in small numbers of patients. 36,37 Our ability to extrapolate these observations to the lower dose of radiation (1200 cGy) in our conditioning regimen is limited by the small number of patients and the difficulty in discriminating between radiationinduced neurologic damage and functional decline due to the primary disease process.…”

Section: Discussionmentioning

confidence: 99%

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Burt

Cohen

Russell

et al. 2003

Blood

189

121

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There were 21 patients with rapidly progressive multiple sclerosis (MS) treated on a phase 1/2 study of intense immune suppressive therapy and autologous hematopoietic stem cell (HSC) support with no 1-year mortality. Following transplantation, one patient had a confirmed acute attack of MS. Neurologic progression defined by the expanded disability status scale (EDSS) did not increase in disability by 1.0 or more steps in any of 9 patients with a pretransplantation EDSS of 6.0 or less. In 8 of 12 patients with high pretransplantation disability scores (EDSS > 6.0), progressive neurologic disability as defined by at least a 1-point increase in the EDSS has occurred and was manifested as gradual neurologic deterioration. There were 2 patients with a pretransplantation EDSS of 7.0 and 8.0 who died from complications of progressive disease at 13 and 18 months following treatment. Our experience suggests that intense immune suppression using a total body irradiation (TBI)-based regimen and hematopoietic stem cell transplantation (HSCT) are not effective for patients with progressive disease and high pretransplantation disability scores. Further studies are necessary to determine the role of intense immune suppressive therapy and HSC support in ambulatory patients with less accumulated disability and more inflammatory disease activity. Specifically, more patients and longer follow-up would be required in patients with an EDSS of 6.0 or less before drawing conclusions on this subgroup.

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“…There are a few case reports of exacerbation of prior MS by cranial radiotherapy [55,56,57] and, in rats, radiotherapy may produce demyelinating lesions [58]. Conversely, total lymphoid irradiation has been used as treatment for MS with either modest benefit or no change [59,60,61,62]. Radiotherapy was given to the mantle zone (chest and neck) in patient 1 and to the nasopharynx in case 5 and may have included the brain stem.…”

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis, Lymphoma and Nasopharyngeal Carcinoma: The Central Role of Epstein-Barr Virus?

Rolls

Giovannoni²,

Constantinescu³

et al. 2009

Eur Neurol

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Background: Multiple sclerosis (MS) and Hodgkin lymphoma (HL) share epidemiologic characteristics suggesting a possible common etiology. Epstein-Barr virus (EBV) is associated with HL, Burkitt lymphoma, some varieties of non-Hodgkin lymphoma (NHL) and nasopharyngeal carcinoma (NPC).Method:Patients were located through MS databases for (a) Barking and Havering, NE London; catchment ∼400,000; MS patient number 751, and (b) Nottingham, catchment ∼2,000,000; MS patient number 1,236. Search was undertaken for lymphoma or NPC and diagnosis of MS verified by McDonald criteria. Results: We identified five UK-born and resident patients of interest: (1) male with onset HL aged 20 years developing relapsing-remitting MS 11 years later; (2) female with severe relapsing-remitting MS whose partner developed NHL, 5 years after MS diagnosis; (3) female with secondary progressive MS beginning at age 38 years who developed NHL 25 years later; (4) female diagnosed with MS aged 19 years who developed HL 4 years later, and (5) female with hereditary motor and sensory neuropathy developing cervical cancer at the age of 32 years, NPC at 33 years, and RR MS at 36 years. Conclusion: Our study supports a possible association between MS, HL, NHL, and perhaps NPC all of which are associated with EBV infection.

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Effect of Total Lymphoid Irradiation in Chronic Progressive Multiple Sclerosis

Cited by 90 publications

References 0 publications

2,000‐Centigray total lymphoid irradiation for refractory rheumatoid arthritis

2,000‐Centigray total lymphoid irradiation for refractory rheumatoid arthritis

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Multiple Sclerosis, Lymphoma and Nasopharyngeal Carcinoma: The Central Role of Epstein-Barr Virus?

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