Myers L W, Ellison G W, Fahey J L, Tesler A, Gottlieb M S
Department of Neurology, UCLA School of Medicine 90024-1769.
Neurology. 1988 Jul;38(7 Suppl 2):38-41.
Success has been reported with use of total lymphoid irradiation (TLI) in organ transplant recipients and in patients with rheumatoid arthritis and other autoimmune diseases. In a well-conducted randomized double blind clinical trial, Cook et al have found that TLI was superior to sham irradiation of patients with multiple sclerosis (MS). However, it is clear from looking at this data that not all patients responded to TLI and that with time disease activity returned. Our own experience with TLI in two MS patients was very disappointing. Despite its apparent benefit in some conditions, considerable drawbacks are associated with TLI. These include high financial cost, unpleasant treatment-related side effects, and the possibility that more serious morbidity as well as mortality may be treatment-related. Furthermore, the optimum therapeutic regimen for TLI has not yet been established. Issues related to cumulative dose, dose per fraction, frequency of fractions, field of irradiation, and interaction with other therapies still need clarification. For these reasons we do not recommend TLI as a treatment for MS.
据报道，在器官移植受者、类风湿性关节炎患者及其他自身免疫性疾病患者中，使用全身淋巴照射（TLI）取得了成功。在一项精心实施的随机双盲临床试验中，库克等人发现，TLI对多发性硬化症（MS）患者的疗效优于假照射。然而，从这些数据中可以清楚地看出，并非所有患者对TLI都有反应，而且随着时间推移，疾病活动会复发。我们自己在两名MS患者身上使用TLI的经验非常令人失望。尽管TLI在某些情况下有明显益处，但它也有相当多的缺点。这些缺点包括高昂的费用、与治疗相关的不良副作用，以及更严重的发病甚至死亡可能与治疗有关的可能性。此外，TLI的最佳治疗方案尚未确定。与累积剂量、分次剂量、分次频率、照射野以及与其他疗法的相互作用相关的问题仍需阐明。出于这些原因，我们不建议将TLI作为MS的一种治疗方法。
