Donor Lymphocyte Infusions

Infusions of lymphocytes obtained via apheresis collections from the patient's allogeneic stem cell donor, i.e., donor lymphocyte infusions (DLIs), have been used as effectors to provide salvage therapy for some patients who have relapsed after allo SCT. The most effective disease targets for this approach have been chronic myeloid leukemia and multiple myeloma, although other hematologic malignancies may respond.57-61 Several small series have reported mixed results in lymphoma patients who relapsed after allo SCT.62-64 In one of the larger series, Mandigers and associates64 treated seven patients with low-grade NHL in relapse after an allo SCT and noted two partial and four durable complete responses lasting at least 43-89 months after infusion. DLIs appear to be more effective in lower grade rather than higher grade NHL and in the setting of low tumor volume. Infusions often are administered after cytotoxic therapy with or without monoclonal antibody therapy and after the patient has been tapered off all immunosuppressive therapy. It is unclear, however, if the GvL effect can be separated from GvHD effect using unmanipulated DLI. The most effective cell dose is not uniformly established, as the time to DLI after the transplant may play a role in efficacy and toxicity. This therapy is associated with a high incidence of GvHD and aplasia of bone marrow, resulting in a nearly 20% fatality incidence.57'60

0 0

Post a comment