Donor lymphocyte infusion
Encyclopedia
Donor lymphocyte infusion (DLI) or buffy coat fusion is a form of adoptive immunotherapy used after hematopoietic stem cell transplantation.
d bone marrow transplant
patients hope of a cure was another bone marrow transplant. However, the risk of serious, life-threatening complications after a second BMT
is great. One strategy of managing relapse, donor leukocyte infusion, might eliminate the need for a second BMT in some patients.
in which lymphocytes from the original stem cell donor are infused, after the transplant, to augment an anti-tumor immune response or ensure that the donor stem cells remain engrafted. These donated white blood cells contain cells of the immune system
that can recognize and destroy cancer cells.
The goal of this therapy is to induce a remission of the patient's cancer by a process called the graft-versus-tumor effect (GVT). The donor T-cells can attack and control the growth of residual cancer cells providing the GVT effect. It is hoped that the donor leukocyte infusion will cause GVT and lead to a remission of the patients cancer.
Patients might require standard chemotherapy
, to reduce the amount of cancer cells they have prior to their donor lymphocyte infusion.
and bone marrow
aplasia
, resulting in immunosuppression
and susceptibility to opportunistic infection
s.
History
Formerly, the only treatment option that offered relapseRelapse
Relapse, in relation to drug misuse, is resuming the use of a drug or a dependent substance after one or more periods of abstinence. The term is a landmark feature of both substance dependence and substance abuse, which are learned behaviors, and is maintained by neuronal adaptations that mediate...
d bone marrow transplant
Bone marrow transplant
Hematopoietic stem cell transplantation is the transplantation of multipotent hematopoietic stem cell or blood, usually derived from bone marrow, peripheral blood stem cells, or umbilical cord blood...
patients hope of a cure was another bone marrow transplant. However, the risk of serious, life-threatening complications after a second BMT
Bone marrow transplant
Hematopoietic stem cell transplantation is the transplantation of multipotent hematopoietic stem cell or blood, usually derived from bone marrow, peripheral blood stem cells, or umbilical cord blood...
is great. One strategy of managing relapse, donor leukocyte infusion, might eliminate the need for a second BMT in some patients.
Procedure
Donor leukocyte infusion is the infusionInfusion
An infusion is the outcome of steeping plants with desired chemical compounds or flavors in water or oil.-History:The first recorded use of essential oils was in the 10th or 11th century by the Persian polymath Avicenna, possibly in The Canon of Medicine.-Preparation techniques:An infusion is very...
in which lymphocytes from the original stem cell donor are infused, after the transplant, to augment an anti-tumor immune response or ensure that the donor stem cells remain engrafted. These donated white blood cells contain cells of the immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
that can recognize and destroy cancer cells.
The goal of this therapy is to induce a remission of the patient's cancer by a process called the graft-versus-tumor effect (GVT). The donor T-cells can attack and control the growth of residual cancer cells providing the GVT effect. It is hoped that the donor leukocyte infusion will cause GVT and lead to a remission of the patients cancer.
Patients might require standard chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
, to reduce the amount of cancer cells they have prior to their donor lymphocyte infusion.
Complications
Complications of DLI include acute and chronic graft-versus-host diseaseGraft-versus-host disease
Graft-versus-host disease is a common complication after a stem cell transplant or bone marrow transplant from another person . Immune cells in the donated marrow or stem cells recognize the recipient as "foreign". The transplanted immune cells then attack the host's body cells...
and bone marrow
Bone marrow
Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...
aplasia
Aplasia
Aplasia is defined in general as "defective development or congenital absence of an organ or tissue." In the field of hematology, the term refers to "incomplete, retarded, or defective development, or cessation of the usual regenerative process."-Examples:*Acquired pure red cell aplasia*Aplasia...
, resulting in immunosuppression
Immunosuppression
Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...
and susceptibility to opportunistic infection
Opportunistic infection
An opportunistic infection is an infection caused by pathogens, particularly opportunistic pathogens—those that take advantage of certain situations—such as bacterial, viral, fungal or protozoan infections that usually do not cause disease in a healthy host, one with a healthy immune system...
s.
Further reading
- Thomas' Hematopoietic Cell Transplantation, ed. Blume KG, Forman SJ, Appelbaum FR. Blackwell Publishers, Cambridge, MA: 2004. ISBN 1-4051-1256-5.