Disease relapse after haematopoietic stem cell transplantation: risk factors and treatment

Best Pract Res Clin Haematol. 2007 Jun;20(2):311-27. doi: 10.1016/j.beha.2006.10.002.

Abstract

Disease relapse is the commonest cause of treatment failure after allogeneic haematopoietic stem-cell transplantation. Adoptive immunotherapy based on donor lymphocyte infusions (DLI) has a prominent role in the management of disease recurrence. Although the highest remission rates are achieved in chronic myeloid leukaemia (CML), encouraging results have also been reported in chronic lymphoproliferative disorders. However, the experience of DLI in CML is not necessarily applicable to the management of lymphoproliferative diseases because of the heterogeneity of the conditioning regimens used in chronic lymphoid malignancies. We will review the role of DLI for different disease types in the context of conventional and reduced-intensity conditioning regimens. The factors influencing response and graft-versus-host disease as well as the optimal cell dose will be discussed. Finally, we will describe the main avenues currently being explored to improve the selectivity and efficacy of DLI.

Publication types

  • Review

MeSH terms

  • Benzamides
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Imatinib Mesylate
  • Leukemia / therapy
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy
  • Lymphocyte Transfusion / adverse effects
  • Lymphocyte Transfusion / methods
  • Piperazines / therapeutic use
  • Pyrimidines / therapeutic use
  • Risk Factors
  • Secondary Prevention*
  • Transplantation, Homologous

Substances

  • Benzamides
  • Piperazines
  • Pyrimidines
  • Imatinib Mesylate