Donor lymphocyte infusion (DLI) is an effective method to induce graft-versus-leukemia (GVL) and is commonly used to treat patients with hematologic malignancies who have relapsed after allogeneic stem cell transplantation or to treat patients with falling donor chimerism after reduced-intensity conditioning. Previous reviews from Europe and North America have reported complete hematologic and cytogenetic response rates in over 75% of patients with stable phase chronic myelogenous leukemia (CML) treated with DLI following hematopoietic stem cell transplantation, although outcomes are significantly worse in other hematologic malignancies.

INDUCTION OF GRAFT - VERSUS - LEUKEMIA

• In patients who need DLI while still on immunosuppression, a rapid taper of immunosuppressants will often result in a graft-versus-host disease (GVHD) flare that can induce a remission or full chimerism.

• In patients who are off all immunosuppression, DLI is a reasonable strategy to induce GVL.

COLLECTION AND ADMINISTRATION OF DONOR LYMPHOCYTE INFUSION

1. Lymphocytes are typically collected without filgrastim stimulation.

2. Cells can be used fresh; however, it is useful to cryopreserve cells in aliquots of 1 to 5 × 107 CD3+ cells/kg body weight.

3. For indolent diseases, administration of cells in gradually increasing numbers separated by 4 to 8 weeks will reduce the risk of GVHD. For instance, start with 1 × 107 CD3+ cells/kg.