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Clinical indications and biological mechanisms of splenic irradiation in autoimmune diseases.
Clinical indications and biological mechanisms of splenic irradiation in autoimmune diseases.
- Source :
-
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] [Strahlenther Onkol] 2001 Feb; Vol. 177 (2), pp. 105-11. - Publication Year :
- 2001
-
Abstract
- Background: Splenic irradiation (SI) is a fairly unknown treatment modality in autoimmune disorders like autoimmune thrombocytopenia (AIT) or autoimmune hemolytic anemia (AIHA), which may provide an effective, low toxic and cost-effective treatment for selected patients.<br />Patients, Materials and Methods: This article reviews the limited experiences on splenic irradiation in autoimmune thrombocytopenia by analyzing the current studies including 71 patients and some preliminary reports on splenic irradiation in autoimmune hemolytic anemia.<br />Results: In autoimmune thrombocytopenia between 40 and 90% of all patients responded, but most of them relapsed within 4 to 6 months after splenic irradiation. Between 10 and 20% of all patients had a sustained response. The efficacy of splenic irradiation in HIV-associated cases of thrombocytopenia is probably lower than in other forms of autoimmune thrombocytopenia, but especially in this group immunosuppressive drug treatment of autoimmune thrombocytopenia exposes some problems. In autoimmune hemolytic anemia there are some case reports about efficacy of splenic irradiation. Toxicity of splenic irradiation in both diseases was very moderate.<br />Conclusions: For HIV patients, for elderly patients or patients at high risk for complications following splenectomy splenic irradiation might be a treatment option. Splenic irradiation as preoperative treatment in patients not responding to or not suitable for immunosuppressive drugs prior to splenectomy may be a promising new application of splenic irradiation to reduce adverse effects of splenectomy in thrombocytopenic patients. A further analysis of the biological mechanisms underlying splenic irradiation may help to improve patient selection, to optimize dose concepts and treatment schedules and will improve understanding of radiotherapy as an immunomodulatory treatment modality.
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Anemia, Hemolytic, Autoimmune drug therapy
Anemia, Hemolytic, Autoimmune surgery
Anti-HIV Agents therapeutic use
Cobalt Radioisotopes therapeutic use
HIV Infections complications
HIV Infections drug therapy
Humans
Immunosuppressive Agents therapeutic use
Particle Accelerators
Patient Selection
Platelet Count
Prospective Studies
Purpura, Thrombocytopenic, Idiopathic drug therapy
Purpura, Thrombocytopenic, Idiopathic surgery
Radioisotope Teletherapy
Radiotherapy Dosage
Recurrence
Risk Factors
Splenectomy
Thrombocytopenia complications
Thrombocytopenia radiotherapy
Time Factors
Anemia, Hemolytic, Autoimmune radiotherapy
Purpura, Thrombocytopenic, Idiopathic radiotherapy
Spleen radiation effects
Subjects
Details
- Language :
- English
- ISSN :
- 0179-7158
- Volume :
- 177
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]
- Publication Type :
- Academic Journal
- Accession number :
- 11233832
- Full Text :
- https://doi.org/10.1007/pl00002384