Donor Leukocyte Infusions (DLI) in the Treatment of AML Patients Relapsed After Allogeneic Bone Marrow Transplantation

Abstract

High-dose chemoradiotherapy and allogeneic bone marrow transplantation (BMT) can cure some patients with acute leukemia and lymphoma. However, approximately 50% of patients relapse after BMT and constitute the group with unfavourable prognosis. Results of salvage chemotherapy in these patients are extremely poor [1], so new alternatives have emerged during the past decade in the field of immunotherapy. The efficacy of allogeneic BMT is usually associated with graft versus host disease (GVHD) and especially with graft versus leukemia (GVL) phenomenon that is carried out by donor’s T-lymphocytes [2]. The absence of GVHD in syngeneic and autologous BMT, T-depletion in allogeneic BMT, more intensive GVHD prophylaxis lead to the higher leukemia relapse rate. It was revealed that induction of GVL effect may be independent of GVHD and can be mediated by cyclosporine A, inter-leukin-2 (IL-2), transfusion of donor’s leukocytes [3, 4, 5]. Those approaches are being used in order to prevent or to treat leukemia relapse after bone marrow transplantation that is to say to prolong disease-free survival. The largest report concerning DLI in relapsed BMT patients comprises 82 cases (chronic myeloid leukemia, acute leukemias) and demonstrates encouraging results [6]. This article will briefly summarise our experience in the treatment of relapses after allogeneic BMT with donor’s leukocytes infusions.