Document 0094
 DOCN  M9440094
 TI    Trial of immunosuppression in amyotrophic lateral sclerosis using total
       lymphoid irradiation [see comments]
 DT    9404
 AU    Drachman DB; Chaudhry V; Cornblath D; Kuncl RW; Pestronk A; Clawson L;
       Mellits ED; Quaskey S; Quinn T; Calkins A; et al; Johns Hopkins
       University, School of Medicine, Baltimore, MD; 21287-7519.
 SO    Ann Neurol. 1994 Feb;35(2):142-50. Unique Identifier : AIDSLINE
       MED/94152998
 CM    Comment in: Ann Neurol 1994 Feb;35(2):129-30
 AB    Although the cause of amyotrophic lateral sclerosis (ALS) remains
       unknown, recent studies have suggested an autoimmune mechanism of
       pathogenesis. Previous trials of immunosuppressive treatment have
       yielded inconclusive results. Our study was designed to determine
       whether more powerful and prolonged immunosuppression, produced by total
       lymphoid irradiation (TLI), would alter the course of ALS. In a
       double-blind, randomized, placebo-controlled study, 30 patients with
       classic ALS were treated with TLI, and 31 were given sham radiation.
       Quantitative measurements of muscle strength, functional motor activity,
       and humoral and cellular immune status were followed for 2 years, or
       until death or respirator dependence. Motor function in the TLI-treated
       and control groups showed no significant differences throughout the
       study. Overall survival was not significantly different in the
       TLI-treated and control groups. TLI effectively suppressed cellular and
       humoral immune function throughout the 2-year study period. Analysis of
       the relationship between immunosuppression and motor functions showed no
       consistent effect of treatment. We conclude that powerful and prolonged
       immunosuppression produced by TLI did not benefit patients with ALS.
       This fails to support the concept of an autoimmune mechanism of
       pathogenesis of ALS.
 DE    Amyotrophic Lateral Sclerosis/IMMUNOLOGY/*RADIOTHERAPY  CD4-CD8 Ratio
       Double-Blind Method  Human  Immunity  *Immunosuppression  Leukocyte
       Count  Placebos  Support, Non-U.S. Gov't  Support, U.S. Gov't, P.H.S.
       CLINICAL TRIAL  JOURNAL ARTICLE  RANDOMIZED CONTROLLED TRIAL

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