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Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation

Berta Sáez, Carles Bravo, Karina Loor, Cristina Berastegui, Manuel Lopez, Victor Monforte, Jordi Giralt, Lina Arbelaez, Roman Antonio
European Respiratory Journal 2014 44: P3323; DOI:
Berta Sáez
1Respiratory Medicine-Universitat Autonoma Barcelona, Hospital Vall d'Hebrón, Barcelona, Spain
2CIBER Enfermedades Respiratorias (CIBERES), Institutode Salud Carlos III, Madrid, Spain
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Carles Bravo
1Respiratory Medicine-Universitat Autonoma Barcelona, Hospital Vall d'Hebrón, Barcelona, Spain
2CIBER Enfermedades Respiratorias (CIBERES), Institutode Salud Carlos III, Madrid, Spain
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Karina Loor
1Respiratory Medicine-Universitat Autonoma Barcelona, Hospital Vall d'Hebrón, Barcelona, Spain
2CIBER Enfermedades Respiratorias (CIBERES), Institutode Salud Carlos III, Madrid, Spain
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Cristina Berastegui
1Respiratory Medicine-Universitat Autonoma Barcelona, Hospital Vall d'Hebrón, Barcelona, Spain
2CIBER Enfermedades Respiratorias (CIBERES), Institutode Salud Carlos III, Madrid, Spain
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Manuel Lopez
1Respiratory Medicine-Universitat Autonoma Barcelona, Hospital Vall d'Hebrón, Barcelona, Spain
2CIBER Enfermedades Respiratorias (CIBERES), Institutode Salud Carlos III, Madrid, Spain
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Victor Monforte
1Respiratory Medicine-Universitat Autonoma Barcelona, Hospital Vall d'Hebrón, Barcelona, Spain
2CIBER Enfermedades Respiratorias (CIBERES), Institutode Salud Carlos III, Madrid, Spain
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Jordi Giralt
3Radiotherapy, Hospital Vall d'Hebrón, Barcelona, Spain
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Lina Arbelaez
3Radiotherapy, Hospital Vall d'Hebrón, Barcelona, Spain
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Roman Antonio
1Respiratory Medicine-Universitat Autonoma Barcelona, Hospital Vall d'Hebrón, Barcelona, Spain
2CIBER Enfermedades Respiratorias (CIBERES), Institutode Salud Carlos III, Madrid, Spain
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Abstract

Introduction: Total lymphoid irradiation (TLI) has been used as a therapeutical option in progressive bronchiolitis obliterans syndrome (BOS) after lung transplantation (LT).

Objective: To assess the safety and efficacy of TLI in patients suffering from BOS after LT.

Methods: 12 lung recipients, 10 bilateral and 2 single LT, were treated with TLI for progressive BOS between 2011 and 2013 and were retrospectively reviewed. Diagnosis of BOS was established by consensus criteria of the International Society of Heart and Lung Transplantation. BOS grades at time of TLI were BOS 1 (25%), BOS 2 (33%) and BOS 3 (42%). Radiation therapy was prescribed as 8 Gy delivered in 0.8-Gy fractions twice a week. Serial pulmonary function tests were performed and adverse effects were identified.

Results: 11 patients completed 10 fractions. Baseline post-transplant FEV1 before TLI was mean (SD) 1.94 (0.7) L and after TLI was 1.13 (0.5) L. The average FEV1 decline before TLI was -0.71 (IC95% -0.95;-0.46)L/year and after TLI was 0.13 (IC95% -0.2; 0.46) L/year. There were 8 cases of marrow suppression and 7 respiratory infections, one of them forcing to stop TLI. Six patients died from advanced BOS after TLI and 1 due to a pulmonary infection.

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Conclusions: TLI as a treatment for progressive BOS was well tolerated and some patients experienced stabilization on FEV1 decline.

  • Transplantation
  • Bronchiolitis
  • Treatments
  • © 2014 ERS
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Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation
Berta Sáez, Carles Bravo, Karina Loor, Cristina Berastegui, Manuel Lopez, Victor Monforte, Jordi Giralt, Lina Arbelaez, Roman Antonio
European Respiratory Journal Sep 2014, 44 (Suppl 58) P3323;

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Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation
Berta Sáez, Carles Bravo, Karina Loor, Cristina Berastegui, Manuel Lopez, Victor Monforte, Jordi Giralt, Lina Arbelaez, Roman Antonio
European Respiratory Journal Sep 2014, 44 (Suppl 58) P3323;
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