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Donor leukocyte infusions

S Mackinnon1

  • 1Department of Haematology, University College London Hospitals, London, UK.

Bailliere'S Clinical Haematology
|June 1, 1997
PubMed
Summary
This summary is machine-generated.

Donor leukocyte therapy offers over 70% remission for chronic myeloid leukemia (CML) relapse post-bone marrow transplant (BMT). However, significant toxicities like graft-versus-host disease (GVHD) necessitate careful T-cell dose management.

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Area of Science:

  • Hematology
  • Immunotherapy
  • Oncology

Background:

  • Allogeneic bone marrow transplantation (BMT) is a treatment for chronic myeloid leukemia (CML).
  • Relapse of CML post-BMT can occur, necessitating further therapeutic interventions.
  • Donor leukocyte infusions (DLI) have emerged as a potential treatment for CML relapse.

Purpose of the Study:

  • To evaluate the efficacy and toxicity of donor leukocyte therapy in patients with relapsed chronic myeloid leukemia (CML) after allogeneic bone marrow transplantation (BMT).
  • To assess response rates in different phases of CML relapse.
  • To explore factors influencing treatment outcomes and potential strategies to mitigate toxicity.

Main Methods:

  • Analysis of remission rates in CML patients undergoing DLI post-BMT.

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  • Categorization of patient responses based on disease phase (cytogenetic, chronic, advanced).
  • Evaluation of treatment-related toxicities, including marrow aplasia and graft-versus-host disease (GVHD).
  • Investigation into the impact of T-cell dose and CD8+ depletion on efficacy and GVHD.

    • Main Results:

    • DLI achieved remission rates exceeding 70% in relapsed CML patients post-BMT.
    • Higher response rates were observed in patients with cytogenetic or chronic-phase hematological relapse compared to advanced-phase CML.
    • Minimal residual disease was undetectable in most responders via BCR-ABL mRNA analysis.
    • Treatment-related mortality was approximately 20%, with major toxicities including marrow aplasia (up to 50%) and GVHD (up to 90%).
    • Lower T-cell doses (1 x 10(7)/kg) or CD8+ depleted leukocytes showed potential for inducing remission with reduced GVHD.

    Conclusions:

    • Donor leukocyte therapy is an effective treatment for CML relapse post-BMT, particularly in earlier disease phases.
    • Significant toxicities, including GVHD, are associated with DLI, highlighting the need for dose optimization.
    • Reducing T-cell dose or employing CD8+ depletion may mitigate GVHD risk while maintaining therapeutic efficacy.
    • Further research is needed to determine optimal DLI schedules and identify all influencing factors for improved outcomes.