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Donor Lymphocyte Infusions Clinical Applications and the Graft‐versus‐Leukemia Effect

  • Chapter
Hematopoietic Stem Cell Transplantation

Part of the book series: Contemporary Hematology ((CH))

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The success of donor lymphocyte infusion (DLI) in inducing long lasting remissions in patients’ chronic myelogenous leukemia provided the first direct evidence of the existence of a Graft‐versus‐Leukemia (GVL) effect. In the decade since the first reports of DLI’s use by Kolb and Slavin, the diseases which response to DLI have been identified and efforts to further enhance the GVL response have been explored [1, 2]. Graft‐versus‐Host‐Disease (GVHD) is the major complication of DLI and strategies aimed at limiting this toxicity have been investigated. Demonstrating the profound antitumor effect mediated by the donor graft has led to the development of nonmyeloablative, or minitransplants, which depend upon the GVL response for success.

Extensive laboratory efforts to identify the effector mechanism of response and potential targets of the GVL reaction have been undertaken. Interestingly, despite the dramatic clinical responses that have been observed, the targets and effector mechanisms of the GVL effect remain unclear. Many potential targets have been proposed including alloantigens, such as minor histocompatibility antigens, as well as tumor‐specific antigens. Responses may be mediated either by cellular mediated direct cytotoxicity, or indirectly via inflammatory cytokines. The role of humoral immunity is also now being explored, and may also play a role in the response to DLI. This chapter will review the clinical applications and outcomes of DLI. We will also discuss future strategies to enhance the GVL response mediated by DLI, with focus on potential targets of the GVL effect.

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  1. Division of Hematology Malignancies, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA

    Edwin P. Alyea

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  1. Edwin P. Alyea
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  1. Division of Hematologic Malignancies, Dana-Farber Cancer Institute, 44 Binney Street, DFCI D1B30, Boston, MA, 02115, USA

    Robert J. Soiffer MD

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Alyea, E.P. (2008). Donor Lymphocyte Infusions Clinical Applications and the Graft‐versus‐Leukemia Effect. In: Soiffer, R.J. (eds) Hematopoietic Stem Cell Transplantation. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-438-4_28

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