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Blood, 1 February 2004, Vol. 103, No. 3, pp. 767-776. Prepublished online as a Blood First Edition Paper on September 4, 2003; DOI 10.1182/blood-2003-02-0342. This Article Full Text Full Text (PDF) All Versions of this Article: 2003-02-0342v1 103/3/767    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kolb, H.-J. Articles by Schendel, D. J. Search for Related Content PubMed PubMed Citation Articles by Kolb, H.-J. Articles by Schendel, D. J. Related Collections Immunobiology Neoplasia Transplantation Immunotherapy Review Articles Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  REVIEW ARTICLES Graft-versus-leukemia reactions in allogeneic chimeras Hans-Jochem Kolb, Christoph Schmid, A. John Barrett, and Dolores J. Schendel From the Department of Medicine III, University of Munich, Munich, Germany; the Clinical Cooperative Group: Hematopoietic Cell Transplantation and the Institute of Molecular Immunology, GSF-National Research Center for Environment and Health, Munich, Germany; and the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD. There is a strong graft-versus-leukemia (GVL) effect of allogeneic stem cell transplantation (SCT) due to elimination of tumor cells by alloimmune effector lymphocytes. When leukemia relapses after allogeneic SCT, donor lymphocyte transfusions (DLTs) can induce sustained remissions in some patients. This review summarizes the current status on clinical use of DLT, the basis of GVL reactions, problems associated with this therapy, and new strategies to improve DLT. Several multicenter surveys demonstrated that the GVL effect of DLT is most effective in chronic myelogenous leukemia (CML), whereas it is less pronounced in acute leukemia and myeloma. Cytokine stimulation to induce differentiation of myeloid progenitor cells or to up-regulate costimulatory molecules on tumor cells may improve the efficacy of DLT. Infections and graft-versus-host disease (GVHD) are major complications of DLT. Control of GVHD may be improved using suicide gene–modified T cells for DLT, allowing T-cell elimination if severe GVHD develops. Hopefully, in the future, GVL effect can be separated from GVHD through adoptive transfer of selected T cells that recognize leukemia-specific antigens or minor histocompatibility antigens, which are expressed predominantly on hematopoietic cells, thereby precluding attack of normal tissues. In patients with leukemia and lymphomas with fast progression, tumor growth may outpace development of effector T cells. Here it may be preferable to select stem cell transplant donors with HLA-mismatches that allow alloreactive natural killer cells, which appear early after transplantation, to retain their cytolytic function. New approaches for adoptive immune therapy of leukemia, which promise a better prognosis for these patients, are being developed. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: N. Beyersdorf, X. Ding, T. Hunig, and T. 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