[Donor leukocyte infusion after allogeneic stem cell transplantation]

Area of Science:

• Immunology
• Hematology
• Oncology

Context:

• Allogeneic stem cell transplantation (SCT) is a curative therapy for hematologic malignancies.
• Relapse of malignancy and infectious complications remain significant challenges post-SCT.
• Adoptive cellular immunotherapy using donor leukocytes offers a promising approach to address these challenges.

Purpose:

• To review the efficacy and toxicities of donor leukocyte infusions (DLIs) in the context of allogeneic SCT.
• To discuss strategies for mitigating DLI-associated toxicities, particularly graft-versus-host disease (GVHD).
• To highlight the successful application of DLIs in managing post-transplant complications.

Summary:

• Donor leukocyte infusions have demonstrated significant success in re-inducing remission for relapsed chronic myelogenous leukemia post-SCT.
• DLIs are effective in preventing and treating post-transplant infections, including Epstein-Barr virus-associated lymphoproliferative disorders and cytomegalovirus infections.
• Key toxicities include graft-versus-host disease and marrow aplasia, with strategies like dose modulation, cell depletion, and gene transfer being explored to manage GVHD.

Impact:

• DLIs represent a powerful tool in the allogeneic SCT setting, improving outcomes for patients with relapsed disease and infections.
• The development of strategies to control GVHD will further enhance the safety and applicability of DLI therapy.
• Restoration of donor-specific immunity through DLI is crucial for long-term disease control and prevention of opportunistic infections.