Donor leukocyte infusions for multiple myeloma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 26; no. 11; pp. 1179 - 1184
• Main Authors: SALAMA, M, NEVILL, T, BARRETT, A. J, HOROWITZ, M, COLLINS, R. H, MARCELLUS, D, PARKER, P, JOHNSON, M, KIRK, A, PORTER, D, GIRALT, S, LEVINE, J. E, DROBYSKI, W
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.12.2000
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - immunology; Chemotherapy; Combined Modality Therapy; Disease control; Female; Graft vs Host Disease - immunology; Graft-versus-host reaction; Humans; Immunotherapy, Adoptive; Leukocyte Transfusion - adverse effects; Leukocytes; Living Donors; Male; Medical sciences; Middle Aged; Multiple myeloma; Multiple Myeloma - drug therapy; Multiple Myeloma - immunology; Multiple Myeloma - therapy; Pancytopenia; Prospective Studies; Retrospective Studies; Stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Blood product; Human; Immunopathology; Transfusion; Leukocyte; Malignant hemopathy; Myeloma; Treatment; Immunoglobulinopathy; Donor; Lymphoproliferative syndrome; Immunotherapy; Adoptive immunization
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1702685

Donor leukocyte infusion (DLI) has well-documented activity in CML, but the role of DLI in other diseases is less well defined. To evaluate the strategy in multiple myeloma (MM) we evaluated 25 MM patients from 15 centers who were treated with DLI. Patients with persistent or recurrent disease after allogeneic BMT received DLI from the original marrow donor (23 matched related, one mismatched family, and one matched unrelated). Chemotherapy was given before DLI in three patients. Two of 22 patients responded completely to DLI alone and three patients responded to the combination of DLI and chemotherapy. Nine patients who had not had sufficient disease control after DLI were given additional DLIs; five of these patients had either complete (two) or partial (three) responses. Thirteen of 25 evaluable patients developed acute GVHD and 11 of 21 evaluable patients developed chronic GVHD; all responders developed GVHD. No patients developed post-DLI pancytopenia. Four patients had responses which lasted >1 year after DLI, three patients had responses which lasted <1 year, and three patients had ongoing responses but with follow-up <1 year. In conclusion, DLI has anti-myeloma activity but the strategy is limited by no response or short duration of response in a significant percentage of patients and by significant GVHD in the majority of the responders.