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Published online by Cambridge University Press: 05 November 2013
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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