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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, may
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 may 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 may 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).
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