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According to a recent article published in the journal Blood, low-dose total body irradiation plus donor lymphocyte infusions appear to produce anti-cancer responses in patients with hematologic (blood) cancers that are unresponsive to standard chemotherapy.

Hematologic cancers include leukemias and lymphomas. Often, patients with these diseases are treated with some type of chemotherapy regimen. However, many patients are not cured with chemotherapy or suffer a cancer recurrence. With the use of more chemotherapy agents over time, the body eventually becomes resistant, or refractory, to treatment with these agents. Once a patient becomes refractory, there are few standard effective therapies.

Donor lymphocyte infusions are a procedure in which a donor’s lymphocytes (white blood cells) are collected and infused into the patient. This strategy relies on the donor lymphocytes recognizing the patient’s cancer cells as “foreign” and mounting an attack against them. However, the donor lymphocytes may also recognize the patient’s healthy tissue as foreign, and mount an attack against the healthy tissue. This is known as “graft-versus-host disease”, which is usually either chronic or acute and can be life threatening. Researchers are evaluating ways in which to prevent or reduce the severity of graft-versus-host disease while maintaining efficacy of the treatment.

Researchers from the University of Massachusetts conducted a clinical trial to evaluate treatment including low-dose total body irradiation plus donor lymphocyte infusions in 12 patients with hematological malignancies. These patients had received an average of 4 prior therapeutic regimens and had stopped responding to therapy. Eleven patients received lymphocytes from siblings and one patient received lymphocytes from cord blood. The patient receiving cord blood did not respond to the infusions. Of the 11 patients who received sibling blood, four achieved a complete disappearance of cancer. Two of these patients are still alive and cancer free. One of these patients died from graft-versus-host-disease and one patient had a cancer recurrence after 5 months of being in remission.

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These researchers concluded that low-dose total body irradiation plus donor lymphocyte infusions may produce responses in patients with refractory hematologic cancer. They stated that the optimal dose of therapy prior to infusion needs to be determined through further clinical trials and the advances in treating graft-versus-host disease may further improve results. However, for this group of patients in which few therapeutic options are available, future clinical trials evaluating low-dose therapy prior to donor lymphocyte infusion are warranted. Patients with refractory hematologic cancers may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating low-dose therapy followed by lymphocyte infusions or other promising therapies.

Reference: Ballen K, Becker P, Emmons R, et al. Low-dose total body irradiation followed by allogeneic lymphocyte infusion may induce remission in patients with refractory hematologic malignancy.

Blood. 2002;100:442-450.

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