Total lymphoid irradiation in rheumatoid arthritis. A ten‐year followup

Abstract

Objective. To report the findings of a 10-year followup of patients enrolled in a randomized trial of total lymphoid irradiation (TLI) versus chemotherapy for rheumatoid arthritis (RA). Methods.A retrospective analysis of the charts of 19 patients who had been included in a randomized trial comparing TLI and chemotherapy for the treatment of RA.Results. Ten years after the start of the trial, a higher number of TLI-treated patients had died (7 of lo), compared with patients who had received chemotherapy (2 of 9). In addition, 3 of the TLI-treated patients developed B cell-related malignancies, whereas no such malignancies developed in the control group.Conclusion. TLI was associated with a lessfavorable long-term outcome than chemotherapy. These data stress the importance of careful long-term followup in experimental trials of immunosuppressive agents.

Treatment of rheumatoid arthritis with total lymphoid irradiation: Long-term survival

“…A sustained reduction in CD4ϩ T cells for up to 10 years has been well documented in TLI-treated patients (6). Since T cells are believed to play a role in RA pathogenesis (12), it is not surprising that efficacy in controlling disease activity was noted with TLI in previous studies.…”

“…Marked lymphopenia was found to persist during followup. More recently, Westhovens et al (6) reported the results of a 10-year followup study of TLI-treated patients, which demonstrated that more TLI-treated patients than controls died (7 of 10 TLItreated patients versus 2 of 9 controls). One TLI-treated patient died of multiple myeloma.…”

“…Fractionated TLI, comprising 2,000 centigray (cGy) applied to the supra-and subdiaphragmatic lymph nodes and spleen, came into use to treat intractable RA Ͼ20 years ago and initial results were reported by our institution and by others (3)(4)(5)(6). This therapy markedly reduces T cells, which are thought to play an important role in the pathogenesis of the disease (1).…”

“…Overall, TLI has appeared to be a promising short-term therapy for RA. Long-term outcomes, however, remain unclear, with some suggestion in recent reports that TLI-treated patients may have poorer outcomes than in patients treated conventionally (6,9).…”

Filtration leukocytapheresis therapy in rheumatoid arthritis: A randomized, double-blind, placebo-controlled trial

“…11), have also been tested for the treatment of refractory RA. With respect to TLI, an unusually high incidence of B cell-related malignancies was revealed in a 10-year followup of TLI-treated patients (12). With respect to TLI, an unusually high incidence of B cell-related malignancies was revealed in a 10-year followup of TLI-treated patients (12).…”