You’ve been through so much already. The diagnosis, the treatments, the hope that came with a stem cell transplant. And then, you get the news that can just knock the wind out of you: the cancer is back. It’s a moment that can feel incredibly heavy, and I see that weight in my patients’ eyes. But I want you to take a breath. There are still powerful options, and one of them is a treatment called Donor Lymphocyte Infusion (DLI). It’s a way to re-energize the fight.
This procedure is a type of immunotherapy, which means we’re using the body’s own defense system to target the cancer. Think of it as a booster shot for your new immune system, giving it a fresh set of eyes to find and fight any remaining cancer cells.
What Is Donor Lymphocyte Infusion?
At its core, Donor Lymphocyte Infusion is a procedure where we give you a collection of healthy white blood cells, specifically lymphocytes, from the same person who donated your stem cells. These lymphocytes are the ‘soldiers’ of the immune system, and they’re experts at recognizing and attacking invaders—including cancer cells.
This “top-up” of donor cells can trigger a powerful reaction called the graft-versus-tumor (GvT) effect. Essentially, the new, vigilant donor cells recognize the cancer as foreign and mount a targeted attack. It’s a sign that the new immune system is getting back to work.
Who Is This Treatment For?
I typically talk to my patients about DLI if they’ve had a blood cancer relapse after an allogeneic (donor) stem cell transplant. It’s a well-established path for several conditions.
| Common Conditions Treated with DLI | |
|---|---|
| Acute Myeloid Leukemia (AML) | Chronic Myeloid Leukemia (CML) |
| Chronic Lymphocytic Leukemia (CLL) | Multiple Myeloma |
| Myelodysplastic Syndromes (MDS) | Non-Hodgkin Lymphoma |
We might also consider DLI if tests show you have mixed chimerism. This just means your bone marrow has a mix of your original cells and the donor’s cells. DLI helps push your body toward full donor chimerism, giving the transplant the best chance of success.
Walking Through the DLI Process
The journey is a team effort, involving you, your care team, and your original donor. It’s a multi-step process, but we’ll be with you the whole way.
Step 1: Getting Ready
First, we need a clear picture of your health. This involves a physical exam and some tests:
- Complete Blood Count (CBC): To check on your blood cell levels.
- Kidney and Liver Function Tests: To ensure your organs are ready.
- Bone Marrow Biopsy: A specialist called a pathologist will look at a small sample of your marrow to see how much cancer is present. If the cancer load is high, we might suggest a short course of chemotherapy first to reduce it, making the DLI more effective.
Step 2: Collecting the Cells from Your Donor
The very same person who gave you their stem cells will donate these lymphocytes. The process is straightforward and is called apheresis.
- A catheter is placed in a vein in one of the donor’s arms.
- Their blood flows into a machine that cleverly separates out the lymphocytes.
- The rest of their blood is returned to them through a second catheter in their other arm.
Sometimes, these cells were already collected and frozen at the time of the original stem cell donation.
Step 3: The Infusion
This part is actually quite quick, usually taking less than 30 minutes.
- We’ll use a catheter, either in your arm or a central line in your chest.
- The bag of donor lymphocytes is connected, and the cells flow into your bloodstream, much like a standard blood transfusion.
- And that’s it. The catheter is removed or flushed.
You might receive several doses of DLI over a few weeks or months, depending on your specific situation and how your body responds.
Benefits and Risks: The Balancing Act
Like any medical procedure, DLI comes with both incredible potential and some risks we need to watch for. It’s a balance. For years, a relapse after transplant often meant facing a second, higher-risk transplant. DLI changed that, offering a path to remission without the intensity of another full transplant.
The biggest risk is something called Graft-versus-Host Disease (GvHD). This is the flip side of the helpful graft-versus-tumor effect. It happens when the donor’s immune cells (the graft) see your healthy body tissues (the host) as a threat and begin to attack them.
We monitor for GvHD very carefully. Here’s what we look out for:
| Potential Complications of DLI | |
|---|---|
| Graft-versus-Host Disease (GvHD) Symptoms | |
| What you might feel or see: | Skin rashes, diarrhea, nausea, vomiting, or jaundice (yellowing of the skin and eyes). |
| How we manage it: | If GvHD develops, we use medications called immunosuppressants to calm the donor immune cells down. |
| Myelosuppression (Bone Marrow Suppression) | |
| What it means: | Your bone marrow slows down, leading to low blood cell counts. This can cause anemia (fatigue, shortness of breath), leukopenia (higher risk of infection), and low platelets (risk of bleeding). |
| How we manage it: | We can manage this with blood or platelet transfusions. If counts don’t recover, we might give you a booster of your donor’s stem cells. |
Recovery and Looking Ahead
After your infusion, we’ll see you for regular follow-up appointments and blood tests. This helps us track your response and keep a close eye out for any signs of GvHD.
The success of DLI really depends on the individual—the type and stage of the cancer, your overall health, and how your immune system responds. We’ll discuss all the specifics as they apply to you.
It’s vital to stay in touch with your care team. Please call your doctor right away if you develop a fever, unusual bleeding, shortness of breath, or any of the GvHD symptoms we discussed.
Take-Home Message
- Donor Lymphocyte Infusion (DLI) is an immunotherapy used to treat blood cancer relapse after a donor stem cell transplant.
- It works by infusing lymphocytes (immune cells) from your original donor to trigger a graft-versus-tumor effect.
- The biggest risk is Graft-versus-Host Disease (GvHD), where the donor cells attack your healthy tissues. We monitor for this very closely.
- The procedure itself is quick, but you will have close follow-up to manage your recovery and response.
- This can be a powerful and effective treatment, offering a path to remission.
Facing a relapse is tough, there’s no doubt about it. But remember, you are not out of options, and you are not alone in this fight. We’re here to walk this next part of the path with you.