Donor Lymphocyte Infusion

Overview

Donor Lymphocyte Infusion (DLI) entails the transfer of healthy white blood cells from a donor to a recipient. This procedure is crucial in boosting the recipient’s immune system to fight against cancer and infections.

DLI is employed when a recipient, who has previously undergone a blood or bone marrow stem cell transplant for blood cancer, experiences a recurrence of the disease. The goal of this treatment is to enhance the recipient’s immune response and potentially eliminate the returning cancer cells.

Reasons for undergoing the procedure

Your doctor may suggest DLI if you experience a relapse following donor blood or bone marrow stem cell transplantation.

DLI is employed by doctors to treat:

• Non-Hodgkin lymphoma.
• Acute Myeloid Leukemia (AML).
• Chronic Lymphocytic Leukemia (CLL).
• Chronic Myeloid Leukemia (CML).
• Multiple myeloma.
• Myelodysplasia (MDS).
• Graft vs. Host Disease (GvHD).

DLI might also be recommended by your doctor if your bone marrow, after transplantation, shows a mix of your own cells and donated cells, known as mixed chimerism. This condition can increase the risk of cancer recurrence. DLI ensures that all your bone marrow cells are derived from the donor, thereby enhancing the effectiveness of the treatment.

Risks

Your doctor will monitor for potential side effects following DLI. If the donor lymphocytes were preserved in Dimethyl Sulfoxide (DMSO), you may experience a reaction to this preservative or notice an unusual smell.

DLI can also lead to certain complications, such as Graft-Versus-Host Disease (GvHD). In GvHD, immune cells from the donor (graft) perceive the recipient’s body cells (host) as foreign and launch an attack against them. Symptoms of GvHD include:

• Nausea and vomiting
• Diarrhea
• Skin rash
• Jaundice

Additional risks associated with DLI include myelosuppression (bone marrow suppression). This condition may result in low blood cell counts, including anemia, leukopenia (low white blood cells), and thrombocytopenia (low platelets). Leukopenia increases susceptibility to infections, anemia can cause fatigue and shortness of breath, and low platelets may lead to bleeding tendencies.

Before the procedure

In addition to conducting a physical examination and discussing your symptoms, your doctor may recommend the following tests:

• Complete Blood Count (CBC)
• Kidney function test
• Liver function test
• Bone marrow biopsy

A pathologist examines tissue samples from the biopsy to determine the presence of any remaining cancer cells. If your cancer cell count is high before DLI, chemotherapy may be necessary to reduce the cancer burden prior to the procedure.

Collecting lymphocytes from the donor for DLI
The individual who gave you their stem cells also gives DLI lymphocytes. The lymphocytes are extracted from your donor’s blood by a doctor. Doctors occasionally freeze the lymphocytes. (They might take this action when your donor gives stem cells for the first time.)

To gather lymphocytes:

• A doctors places a flexible tube, or catheter, into a vein in the arm of your donor to withdraw blood.
• The technique known as apheresis involves passing blood through a device that divides mononuclear cells, which are the cells that contain lymphocytes.
• Blood travels from the device to a catheter and then returns to the vein in the other arm of your donor.

During the procedure

The following procedures are followed when infusing donor lymphocytes:

• The doctor places a catheter in your arm or chest.
• Your blood is infused with lymphocytes extracted from your donor via the catheter.
• The catheter is removed by your doctor.
• If you have a central line, your doctor will flush the line or consider removing the catheter.

Donor lymphocyte infusion can induce a Graft-Versus-Tumor (GvT) effect, where donated T-cells recognize and attack remaining cancer cells post bone marrow or stem cell transplant. GvT signifies the donor immune system’s active role in fighting blood cancer.

The infusion of lymphocytes typically takes about 30 minutes to administer. Over several weeks or months, multiple doses may be given.

Outcome

Discuss with your doctor the timing for resuming your regular activities after DLI. Your follow-up plan will include blood tests and appointments to monitor your response to DLI. Additionally, your doctor will monitor for signs and symptoms of Graft-Versus-Host Disease (GvHD).