Donor leukocyte infusions after unrelated donor hematopoietic stem cell transplantation.
OBJECTIVE
Donor leukocyte infusions provide direct and potent graft-versus-tumor activity to treat relapse after allogeneic stem cell transplantation. Extensive data are available on the use of donor leukocyte infusion after matched-sibling stem cell transplantation, but reports are remarkably few on the use of donor leukocyte infusion after unrelated-donor stem cell transplantation. But the role for unrelated-donor leukocyte infusion is not well established.


RESULTS
The dramatic success of donor leukocyte infusion to treat relapse after matched-sibling stem cell transplantation has led to the use of unrelated-donor leukocyte infusion in many patients. Several case studies suggest that unrelated-donor leukocyte infusion effectively induces direct graft-versus-tumor reactions with toxicity comparable to that of matched-sibling donor leukocyte infusion. Important issues include the relationship between dose and response/toxicity appropriate timing, dose, and schedule; and identification of the best tumor targets. In particular nonmyeloablative transplant strategies using unrelated donors are expanding rapidly, but relapse rates are high. There is a paucity of data on unrelated-donor leukocyte infusion in this setting.


CONCLUSIONS
This review summarizes recent data on the use of unrelated-donor leukocyte infusion. We discuss anticipated outcomes and identify areas under active investigation in both ablative and nonmyeloablative unrelated-donor stem cell transplantation.
Loren
Alison W
AW
Stem Cell Transplant Program and Hematology-Oncology Division, Abramson Cancer Center, University of Pennsylvania, Philadelphia, 19104, USA.
Porter
David L
DL
D002986:Clinical Trials as Topic; D004306:Dose-Response Relationship, Immunologic; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology; D020544:Graft vs Leukemia Effect / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007938:Leukemia / Q000276:immunology / Q000628:therapy; D017708:Leukocyte Transfusion / Q000009:adverse effects; D019520:Living Donors; D008212:Lymphocyte Depletion; D013601:T-Lymphocytes / Q000276:immunology / Q000637:transplantation