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.
Conclusions: TLI as a treatment for progressive BOS was well tolerated and some patients experienced stabilization on FEV1 decline.
- © 2014 ERS
