Over the past 25 years, bone marrow transplantation has increased cure and long-term survival rates for patients diagnosed with leukemia and other blood disorders. Nonetheless, many patients who successfully weather the risks and complications of a BMT later relapse.
Formerly, the only treatment option that offered relapsed bone marrow transplant (BMT) 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, called donor leukocyte infusion, might eliminate the need for a second BMT in some patients.
What is donor leukocyte infusion?
Donor leukocyte infusion is the infusion of your donor's lymphocytes (white blood cells), obtained from blood donated by your original bone marrow donor. 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 your 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 your cancer.
Your donor will be contacted to begin the collection process, which can be like the original bone marrow donation process. After these cells are collected, they will be infused.
You might require standard chemotherapy to reduce the amount of cancer you have prior to your donor lymphocyte infusion. Following your donor lymphocyte infusion, you will be continually monitored.
Who can benefit from a donor leukocyte infusion?
The majority of donor leukocyte infusions have been given to patients with relapsed chronic myelogenous leukemia (CML), although patients with relapsed acute leukemia, chronic lymphocytic leukemia (CLL), myelodysplasia (MDS), non-Hodgkin's lymphoma, Hodgkin's disease, and multiple myeloma have also been treated successfully with a donor leukocyte infusion.
What are the possible side effects of this procedure?
Unfortunately, graft-versus-host disease (GvHD) often accompanies graft-versus-leukemia effect. In GvHD, the donated bone marrow or stem cells view the recipient’s body as foreign, and the donated cells/bone marrow attack the body.
GvHD can affect the skin, liver, and intestinal tract. GvHD is occasionally life-threatening
and often requires admission to the hospital for treatment.
GvHD treatment is usually steroids which suppress the immune system and sometimes can lead to infections. GvHD, and its treatment, can be fatal.
Another potential side effect of donor leukocyte infusions is bone marrow suppression, which results in a decreased white blood cell count. In most cases, the problem is short-term and resolves itself without treatment. In some cases, the problem is resolved with the help of growth factors or a "booster" injection of donor cells. If the condition does not resolve, you might require blood or platelet transfusions.
Future of donor leukocyte infusions
Because of the success of DLI, investigators are now searching for ways to increase the effectiveness of donor leukocyte infusions and minimize its side effects.
(NOTE: This information was adapted from Bone Marrow Transplant Newsletter, Vol. 7, No. 4, July 1996 edition).
- What’s new in acute lymphocytic leukemia research?
www.cancer.org Accessed 12/10/2012
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