PURPOSE: To assess the safety and efficacy of @entity706 ( @entity706 ) in @entity1 experiencing chronic rejection following bilateral lung transplantation (BLT). @entity1 AND MATERIALS: Eleven @entity1 received @entity706 for chronic allograft rejection ( @entity4154 ) refractory to conventional treatment modalities. @entity1161 ( @entity1161 ) was prescribed as 8 Gy delivered in 10 0.8-Gy fractions, 2 fractions/week, via mantle, paraaortic, and inverted-Y fields. Serial pre- and post- @entity1161 pulmonary function values, complete blood counts, and immunosuppressive augmentation requirements [use of @entity1667 , murine anti-human mature T-cell monoclonal antibody (OKT3), polyclonal antithymocyte globulin (ATG), and @entity1140 ] were monitored. RESULTS: In the 3 months preceding @entity706 , the average decrease in forced expiratory volume in 1 s (FEV1) was 34% (range 0-75%) and the median number of immunosuppression augmentations was 3 (range 0-5). Only 4 of 11 @entity1 completed all 10 @entity706 treatment fractions. Reasons for discontinuation included progressive @entity358 (four @entity1 ), worsening @entity358 (two @entity1 ), and persistent @entity882 (one @entity1 ). Seven of the 11 @entity1 failed within 8 weeks of treatment cessation. One @entity1 had unabated rejection and received bilateral living related-donor transplants; he is alive and well. Six @entity1 died. Two of these @entity204 were due to @entity358 from organisms isolated prior to the start of @entity1161 ; the other four @entity204 were from progressive @entity358 . The four remaining @entity1 had durable positive responses to @entity706 (mean follow-up of 47 weeks; range 24-72). Comparing the 3 months preceding @entity1161 to the 3 months following treatment, these four @entity1 had improvements in average FEV1 (40% decline vs. 1% improvement) and fewer median number of immunosuppressive augmentations (3.5 vs. 0). None of these @entity1 has developed @entity1071 or has died. Features suggestive of a positive response to @entity706 included longer interval from transplant to @entity1161 , higher FEV1 at initiation of @entity1161 , and absence of preexisting @entity358 . CONCLUSION: Total lymphoid irradiation for chronic allograft rejection refractory to conventional medical management following BLT was tolerable. A subset of @entity1 experienced durable preservation of pulmonary function and decreased immunosuppressive requirements. @entity1 with rapidly progressive allograft rejection, low FEV1, or preexisting @entity281 were least likely to benefit from irradiation. Early initiation of @entity706 for @entity1 experiencing chronic allograft rejection following BLT may be warranted.

Efficacy of XXXX for chronic allograft rejection following bilateral lung transplantation.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'PATIENTS'] @entity1667 :: ('MESH:D008775', 'Chemical') :: ['methylprednisolone'] @entity1071 :: ('MESH:D008232', 'Disease') :: ['lymphoproliferative disease'] @entity706 :: ('MESH:D008223', 'Disease') :: ['TLI', 'total lymphoid irradiation'] @entity882 :: ('MESH:D013921', 'Disease') :: ['thrombocytopenia'] @entity1161 :: ('MESH:D011832', 'Disease') :: ['RT', 'Radiation therapy'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity358 :: ('MESH:D008171', 'Disease') :: ['pulmonary decline', 'pulmonary infection'] @entity1140 :: ('MESH:D016559', 'Chemical') :: ['tacrolimus'] @entity4154 :: ('MESH:D001989', 'Disease') :: ['bronchiolitis obliterans syndrome'] @entity204 :: ('MESH:D003643', 'Disease') :: ['deaths']
@entity706 :: (MESH:D008223,Disease) :: ['total lymphoid irradiation']
