Mononuclear Cell Preparations

Publisher Summary This chapter focuses on the use of mononuclear cell (MNC) preparations for immunotherapy, including unmanipulated cells as well as cells processed in vitro to serve specific immunologic functions—for example, cytotoxic T-lymphocytes and dendritic cells. Transfusion of MNCs is a relatively new practice; therefore, many of the indications for their usage as well as the protocols for cell preparation are still under development. The infusion of donor cells is referred to in several ways such as donor leukocyte infusion (DLI), adoptive immunotherapy, and allogeneic cell therapy. MNCs can be used for various purposes in the postallogeneic transplant setting. Donor MNCs have been effective in inducing remission when there is relapse of malignancy and are also useful in fighting infections in the post-transplant setting. Orders for DLI must be written by the patient's physician with certain specifications: donor identification, recipient information, dose of desired cell population, required processing (e.g., CD4 selection and expansion of antigen-specific cells), and whether to infuse the cells fresh or after cryopreservation. Both the patient and the donor must be informed of the risks and benefits of the procedure and each should sign a consent form documenting the discussion. There are no absolute indications for DLI as their use is still experimental. Because the use of these cell populations is not standard, all clinical protocols that include infusion of these populations should first be submitted to the local institutional review board for approval.