Adoptive immunotherapy denotes the transfer of immunocompetent cells for the treatment of
leukemia,
cancer, or
viral disease. It has regained much interest through the success of treating recurrent
leukemia after allogeneic
bone marrow transplantation with the transfusion of donor lymphocytes. Chimerism and transplantation tolerance toward the donor offer the possibility of adoptive immunotherapy using donor lymphocytes. In animal studies, donor lymphocytes could be transfused into the chimeric animal, if the transfusion was delayed after marrow
transplantation. Transfused lymphocytes exhibit a graft-versus-
leukemia effect and increase chimerism. Immunity could be transferred and immune reactivity toward new
antigens improved. In human patients transfusion of donor lymphocytes was studied in
leukemia recurring after marrow
transplantation. It was very effective in the treatment of
chronic myelogenous leukemia recurring after marrow
transplantation. It was also effective in some patients with
acute myeloid leukemia,
myelodysplastic syndrome and myeloma; in
acute lymphoblastic leukemia and
lymphoma responses were rare. Responses in solid
tumors as
breast cancer have been described. Major complications are
graft-versus-host disease and myelosuppression. Myelosuppression could be compensated by the transfusion of marrow.
Graft-versus-host disease can be modified by the depletion of CD8-positive T cells from the lymphocyte concentrate or by transfusing very low numbers of cells and increasing doses in a stepwise fashion. The role of concomitant treatment with
cytokines and activation of T cells by dendritic cells and vaccination remains to be defined.