Combination total lymphoid irradiation and low‐dose corticosteroid therapy for progressive multiple sclerosis

Total lymphoid irradiation (TLI) has been reported to delay deterioration in patients with progressive multiple sclerosis and other autoimmune disorders. Methods— In an open trial, the effect of TLI combined with a one year course of low dose prednisone was compared to the effect of sham TLI and TLI only in a prior double‐blind study of patients with progressive multiple sclerosis. Results— Twenty‐seven patients receiving TLI combined with corticosteroids had significantly greater lymphocytopenia in the year post‐therapy than those receiving TLI only or sham TLI and Kaplan Meier product‐limit survival analysis showed significantly less progression in the TLI plus steroid group over 4 years of follow‐up. No difference in lymphocytopenia or progression was found with TLI plus corticosteroid therapy when the spleen was removed from the field of irradiation. Conclusion— These results lend further support to the hypothesis that TLI may be effective in progressive MS, and indicates that adding low‐dose prednisone may enhance this effect. The study also suggests that TLI may be equally effective whether or not the spleen is irradiated.