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DONOR LYMPHOCYTE INFUS I ON (DLI) Dr. Serdar ŞIVGIN February 2011 Kayseri
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DLI Marrow transplantation was initially developed as a procedure to rescue atomic bomb survivors from marrow aplasia induced by high-dose total body irradiation (TBI).
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DLI Donor leukocyte infusion (DLI) is a form of adoptive immunotherapy in which a patient with a hematologic malignancy who has previously received an allogeneic bone marrow transplant has relapsed. The leukocytes are obtained from the original bone marrow donor through a leukapheresis procedure.
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DLI The principle use of donor leukocyte infusion (also know as donor lymphocyte or buffy coat transfusion) is to induce a graft-versus -tumor response by introducing white blood cells from the donor to the patient.
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DLI The objective is for the donor leukocyte cells to recognize the cancer cells and destroy them. This differs from a repeat bone marrow transplant in that no chemotherapy is given prior to the infusion and the T-cells (which are part of the body’s immune system and fights infection) are not depleted.
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DLI DLI is considered a salvage therapy at the time of relapse. DLI has been proposed for a variety of hematologic malignancies including; CML, AML, ALL, multiple myeloma, CLL, MDS, Hodgkin’s disease, and NHL.
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DLI Graft-vs-host disease (GVHD) was a major cause of transplant-related mortality, but circumstantial evidence suggested that donor T cells, the mediators of GVHD, could also induce a therapeutic“graft-vs- leukemia” (GVL) effect.
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DLI Important characteristics of DLI that remain true today are: First, there is a relationship between the infused cell dose and the likelihood of a clinically significant antitumor response. Second, the antitumor response mediated by donor immunocompetent cells goes hand in hand with GVHD.
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DLI is an established therapy of hematologic malignanciesin relapse after allogeneic SCT. DLI induces sustained complete remissions in more than 60% of patients with CML in early stage relapse but in fewer than 20% of patients with acute leukemia, multiple myeloma, and lymphoma.
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Complications of Donor Lymphocyte Infusions Graft-vs-Host Disease Aplasia Infection
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DLI The majority of patients experiencing myelosuppression after DLI recover a normal blood cell count spontaneously. But, myelosuppression may be fatal approximately 10% of patients, with death being caused by infection or bleeding.
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DLI Grade II-IV acute GvHD develops in almost half of patients (50 %) given DLI. The highest incidence being observed when the donor is an unrelated volunteer.
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DLI In fact, only 20- 30% of patients with AML achieve a hematologic remission after DLI and the value for patients with ALL is even lower. DLI can provide a direct GVL effect and offer an effective therapy for relapsed hematologic malignancies after hematopoietic stem cell transplantation.
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DLI One of the most important, still unsolved problem of DLI is that concerning the much lower efficacy of GVL in patients with acute leukemia than in those with CML. The more encouraging results obtained when DLI is used as consolidation therapy for patients who have obtained a complete remission after chemotherapy.
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