Dli

• May be used in CML, AML and ALL, NHL, HL and myeloma.

• DLI can promote full donor chimerism in patients with mixed chimerism or residual tumour after reduced intensity non-myeloabla-tive conditioning.

• Patient should discontinue cyclosporin and steroid therapy at least 2 weeks before DLI and chemotherapy at least 24h before DLI.

• Donor lymphocytes are collected by leucapheresis; a typical collection of 150mL contains ~50 x 108 T lymphocytes.

• Escalating doses are generally used to limit GvHD e.g. first dose 107 donor lymphocytes followed 12 weeks later if no response by 5 x 107 cells, then if no response 12 weeks later 108 cells then >108 cells 12 weeks later if no response; lower initial doses and increments are utilised in MUD SCT.

• Where possible e.g. CML, AML molecular monitoring may be undertaken and DLI may be utilised for molecular relapse with molecular monitoring of response.

• The main adverse effect of DLI is acute or chronic GvHD especially if administered early after SCT. The incidence of these complications has been reduced by the adoption of an escalating dose regimen but increased with MUD SCT.

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