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

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

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

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 < 0.05 at 6, 12, and 18 months), and the difference in mean functional impairment score between groups became progressively greater (p < 0.01 at 42 and 48 months). Benefit accrued principally to the 17 TLI-treated patients with absolute blood lymphocyte counts < 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 < 0.05 to p < 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 progresive 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.

Original languageEnglish (US)
Pages (from-to)32-37
Number of pages6
JournalNeurology
Volume38
Issue number7 SUPPL. 2
StatePublished - 1988
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

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