不同慢性肺移植功能障碍表型中环磷酰胺全身照射的疗效和安全性。
Efficacy and safety of total lymphoid irradiation in different chronic lung allograft dysfunction phenotypes.
机构信息
Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
Lung Transplant Unit, Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain.
出版信息
Clin Transplant. 2023 Feb;37(2):e14891. doi: 10.1111/ctr.14891. Epub 2023 Jan 17.
Total lymphoid irradiation (TLI) is an alternative treatment for chronic lung allograft dysfunction (CLAD). However, data regarding its efficacy and tolerance are scarce. This study included patients with CLAD treated with TLI at our center between 2011 and 2018. Clinical characteristics before and after TLI and related complications were analyzed. Forty patients with CLAD (twenty-nine bronchiolitis obliterans syndrome [BOS], nine restrictive allograft syndrome [RAS], and two mixed) were included. Significant attenuation of the forced expiratory volume in 1-sec (FEV ) decline slope was observed in all phenotypes, in both the BOS and RAS. The median FEV 12, 6, and 3 months pre-TLI were as follows: 1980 (IQR 1720-2560), 1665 (IQR 1300-2340) and 1300 (IQR 1040-1740) ml (p < .001), while the median FEV at 3, 6, and 12 months post-TLI was 1110 (IQR 810-1440), 1130 (IQR 860-1470), and 1115 (IQR 865-1490) ml (p = .769). No dropouts due to radiation toxicity were observed. The mean survival according to the Karnofsky Performance Status Scale (KPS) >70 or ≤70 at baseline was 1837 (IQR 259-2522) versus 298 (IQR 128-554) days (p < .0001), respectively. In conclusion, TLI may stop FEV decline in both BOS and RAS. Moreover, a good KPS score may be an important prognostic factor.
全身淋巴照射（TLI）是治疗慢性肺移植物功能障碍（CLAD）的一种替代方法。然而，关于其疗效和耐受性的数据很少。本研究纳入了 2011 年至 2018 年在我中心接受 TLI 治疗的 CLAD 患者。分析了 TLI 前后的临床特征和相关并发症。共纳入 40 例 CLAD 患者（29 例闭塞性细支气管炎综合征[BOS]，9 例限制性移植物综合征[RAS]，2 例混合性）。所有表型均观察到 1 秒用力呼气量（FEV ）下降斜率明显减弱，BOS 和 RAS 均如此。TLI 前 12、6 和 3 个月的中位 FEV 1 分别为：1980（IQR 1720-2560）、1665（IQR 1300-2340）和 1300（IQR 1040-1740）ml（p<0.001），而 TLI 后 3、6 和 12 个月的中位 FEV 分别为 1110（IQR 810-1440）、1130（IQR 860-1470）和 1115（IQR 865-1490）ml（p=0.769）。未观察到因放射性毒性而导致的失访。根据 Karnofsky 表现状态量表（KPS）基线时>70 或≤70 的平均生存率分别为 1837（IQR 259-2522）和 298（IQR 128-554）天（p<0.0001）。总之，TLI 可能会阻止 BOS 和 RAS 中 FEV 的下降。此外，良好的 KPS 评分可能是一个重要的预后因素。
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