Graft-versus-host disease after donor leukocyte infusions: presentation and management

Abstract

Donor leukocyte infusion (DLI) is used after both myeloablative and non-myeloablative stem-cell transplantation to treat and prevent relapse, to establish full donor chimerism, and to treat and prevent infections. The major treatment-related complication of DLI is graft-versus-host disease (GVHD). The presentation and treatment of GVHD after DLI is similar to its presentation and treatment after stem-cell transplantation, with some notable exceptions. While GVHD and graft-versus-tumor (GVT) effects are highly correlated after DLI, some patients experience remission without GVHD. Studies to define tumor-specific target antigens and GVT effector cells, as well as strategies of donor T-cell manipulation and optimization of DLI dose and schedule, may ultimately lead to the consistent ability to separate GVHD from GVT activity, improvement in the safety and specificity of DLI, and enhancement of the anti-tumor activity of donor T cells.

Figures

Figure 1

Probability of acute and chronic graft-versus-host disease (AGVHD and CGVHD) after bulk-dosing regimen (BDR) versus escalating-dose regimen (EDR) donor leukocyte infusion (DLI). Reprinted from Dazzi et al (2000, Blood 95: 67–71) with permission.

Figure 2

Correlation of donor leukocyte infusion (DLI) cell dose with acute graft-versus-host disease (GVHD) after unrelated stem-cell transplantation (USCT). After unrelated DLI, no correlation between cell dose and the incidence of acute GVHD was identified. Reprinted from Collins et al (2000, Bone Marrow Transplantation 26: 511–516) with permission.