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Total lymphoid irradiation for multiple sclerosis.

C K Devereux1, R Vidaver, M P Hafstein

  • 1Department of Radiation Oncology, Clara Maass Medical Center, Belleville, NJ 07109.

International Journal of Radiation Oncology, Biology, Physics
|January 1, 1988
PubMed
Summary
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Modified total lymphoid irradiation (TLI) effectively treats progressive multiple sclerosis (MS) with reduced toxicity. This immunosuppressive therapy showed significant clinical benefits compared to sham irradiation in MS patients.

Area of Science:

  • Immunology
  • Neurology
  • Radiation Oncology

Background:

  • Chemical immunosuppression offers benefits for chronic progressive multiple sclerosis (MS) but carries oncogenic risks.
  • Standard total lymphoid irradiation (TLI) regimens require modification to mitigate toxicity in MS patients.

Purpose of the Study:

  • To evaluate the efficacy and safety of a modified total lymphoid irradiation (TLI) regimen in patients with chronic progressive multiple sclerosis (MS).

Main Methods:

  • A randomized double-blind trial comparing a modified TLI regimen (1,980 rad) with sham irradiation in 40 MS patients.
  • Modifications included reduced radiation dose, adjusted field margins, spinal cord shielding, and kidney protection.
  • Clinical efficacy assessed by functional scale deterioration and lymphocyte counts over 24 months, with 3-year follow-up.

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Main Results:

  • TLI treatment resulted in significantly less functional scale deterioration at 12 and 18 months compared to sham irradiation (16% vs. 55% and 28% vs. 63%, respectively).
  • Therapeutic benefit correlated with reduced lymphocyte counts 3 months post-irradiation.
  • Toxicity was generally mild and transient; notable adverse events included induced menopause in 2 patients and staphylococcal pneumonia in one.

Conclusions:

  • The modified TLI regimen demonstrates clinical efficacy and acceptable toxicity for treating progressive MS.
  • This approach is suitable for further investigation as an immunosuppressive treatment for progressive MS and other non-malignant conditions.