Donor Lymphocyte Infusion
What is donor lymphocyte infusion?
Donor lymphocyte infusion (or DLI) is the infusion (transfer) of a bone marrow transplant donor's lymphocytes into a recipient’s body. This procedure may be done after the original transplant if the recipient of the transplant suffers a return of their cancer.
Lymphocytes — a type of leukocyte, or white blood cell — are taken from the blood given by the original blood transplant donor. These donated white blood cells contain cells of the immune system that recognize and destroy cancer cells.
Over the past several years, bone marrow transplantation has increased cure and long-term survival rates for those diagnosed with leukemia and other blood disorders. Unfortunately, many people who successfully weather the risks and complications of a BMT later relapse.
For years the only treatment option that offered relapsed bone marrow transplant patients hope of a cure was another bone marrow transplant. However, the risk of serious, life-threatening complications after a second BMT is great.
The donor lymphocyte infusion is one strategy of managing relapse.
The goal of DLI is remission of cancer by a process called the graft-versus-tumor effect (GVT),where the donor T-cells attack and control the growth of residual cancer cells. Donors are contacted to begin the collection process, which can be like the original bone marrow donation process. After these cells are collected, they’re infused into the recipient’s body.
Before donor lymphocyte infusion, standard chemotherapy may be needed to reduce the amount of cancer the recipient may still have.
Risks / Benefits
Who can be helped by donor lymphocyte infusions?
The majority of donor lymphocyte infusions have been given to patients with relapsed chronic myelogenous leukemia (CML). Other diseases that have been treated successfully with donor lymphocyte infusions include:
- Relapsed acute leukemia.
- Chronic lymphocytic leukemia (CLL).
- Myelodysplasia (MDS).
- Non-Hodgkin's lymphoma.
- Hodgkin's disease.
- Multiple myeloma.
What are the possible side effects of a donor lymphocyte infusion?
Unfortunately, graft-versus-host disease (GvHD) often accompanies graft-versus-tumor effect. In GvHD, the donated bone marrow or stem cells view the recipient’s body as foreign, and the donated cells/bone marrow attack the body.
GvHD can affect the skin, liver and intestinal tract. GvHD is occasionally life-threatening and often requires admission to the hospital for treatment.
GvHD treatment is usually steroids that suppress the immune system and sometimes can lead to infections. GvHD, and its treatment, can be fatal.
Another potential side effect is bone marrow suppression, which results in a decreased white blood cell count. In most cases, the problem is short-term and resolves itself without treatment. In some cases, the problem is resolved with the help of growth factors or a "booster" injection of donor cells. If the condition doesn’t resolve, blood or platelet transfusions may be needed.
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