Book contents
- Frontmatter
- Contents
- Acknowledgments
- Contributor
- 1 Rationale for transplantation
- 2 Types of transplantation
- 3 Human leukocyte antigen matching in allogeneic transplantation
- 4 Stem cell source
- 5 Pretransplant evaluation and counseling of patient and donor
- 6 Conditioning regimens
- 7 Stem cell infusion
- 8 ABO compatibility
- 9 Engraftment
- 10 Preventative care
- 11 Transplant-related complications
- 12 Overview of acute and chronic graft-versus-host disease
- 13 Acute graft-versus-host disease and staging
- 14 Graft-versus-host disease prophylactic regimens
- 15 Treatment guidelines for acute graft-versus-host disease
- 16 Chronic graft-versus-host disease
- 17 Engraftment syndrome
- 18 Infectious disease
- 19 Graft rejection and failure
- 20 Gastrointestinal complications
- 21 Oral health in stem cell transplantation
- 22 Pulmonary complications
- 23 Veno-occlusive disease
- 24 Special transfusion-related situations
- 25 Cardiovascular complications
- 26 Neurologic complications
- 27 Cystitis
- 28 Donor lymphocyte infusion
- 29 Transplantation: regulation and accreditation
- Index
- References
28 - Donor lymphocyte infusion
Published online by Cambridge University Press: 05 November 2013
- Frontmatter
- Contents
- Acknowledgments
- Contributor
- 1 Rationale for transplantation
- 2 Types of transplantation
- 3 Human leukocyte antigen matching in allogeneic transplantation
- 4 Stem cell source
- 5 Pretransplant evaluation and counseling of patient and donor
- 6 Conditioning regimens
- 7 Stem cell infusion
- 8 ABO compatibility
- 9 Engraftment
- 10 Preventative care
- 11 Transplant-related complications
- 12 Overview of acute and chronic graft-versus-host disease
- 13 Acute graft-versus-host disease and staging
- 14 Graft-versus-host disease prophylactic regimens
- 15 Treatment guidelines for acute graft-versus-host disease
- 16 Chronic graft-versus-host disease
- 17 Engraftment syndrome
- 18 Infectious disease
- 19 Graft rejection and failure
- 20 Gastrointestinal complications
- 21 Oral health in stem cell transplantation
- 22 Pulmonary complications
- 23 Veno-occlusive disease
- 24 Special transfusion-related situations
- 25 Cardiovascular complications
- 26 Neurologic complications
- 27 Cystitis
- 28 Donor lymphocyte infusion
- 29 Transplantation: regulation and accreditation
- Index
- References
Summary
Donor lymphocyte infusion(DLI) is an effective method to induce graft-versus-leukemia (GVL) and iscommonly used to treat patients with hematologic malignancies who haverelapsed after allogeneic stem cell transplantation, or to treat patientswith falling donor chimerism after reduced-intensity conditioning. Previousreviews from Europe and North America have reported complete hematologic andcytogenetic response rates in over 75% of patients with stable-phase chronicmyelogenous leukemia (CML) treated with DLI following HSCT, althoughoutcomes are significantly worse in other hematologic malignancies.
Induction of GVL
In patients who need DLI while still on immunosuppression, a rapid taper of immunosuppressants will often result in a GVHD flare that can induce remission or full chimerism.
In patients who are off all immunosuppression, DLI is a reasonable strategy to induce GVL.
Collection and administration of DLI
Lymphocytes are typically collected without filgrastim stimulation.
Cells can be used fresh; however, it is useful to cryopreserve cells in aliquots of 1 to 5 x 107 CD3+ cells/kg body weight.
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 x 107 CD3+ cells/kg. If there is no GVHD and the desired response has not been achieved by 6 weeks, increase the dose to 5 x 107 CD3+ cells/kg. Doses beyond 108 CD3+ cells/kg are usually not desirable.
For aggressive diseases, typical doses of 108 CD3+ cells/kg are administered as a single dose.
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- Information
- Manual of Stem Cell and Bone Marrow Transplantation , pp. 179 - 180Publisher: Cambridge University PressPrint publication year: 2013