Donor lymphocyte infusion is a procedure that transfers healthy white blood cells (lymphocytes) from your bone marrow or stem cell donor to your blood. An infusion of healthy lymphocytes helps your immune system get rid of remaining cancer cells if you have a relapse after a bone marrow or stem cell transplant for blood cancer.
Donor lymphocyte infusion (DLI) is a procedure that transfers (infuses) healthy white blood cells from a donor to a recipient. Lymphocytes are cells that help your immune system fight cancer and infections.
If you received donor blood or a bone marrow stem cell transplant to treat blood cancer, but then the cancer came back, donor lymphocyte infusion can help.
Your healthcare provider might recommend donor lymphocyte infusion if you have a relapse after receiving donor blood or undergoing bone marrow stem cell transplantation.
Healthcare providers use DLI to treat:
Your provider may also recommend DLI if your bone marrow contains a mix of your cells and donated cells after transplant. This condition, known as mixed chimerism, can increase your risk of relapse. DLI helps make sure all of your bone marrow cells are from your donor. This maximizes the effectiveness of treatment.
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Your healthcare provider does a physical examination and talks with you about your symptoms. They may also run tests, which may include:
If you have a biopsy, a pathologist examines tissue samples to check if cancer cells remain. If you have a high level of cancer cells, you may need chemotherapy before the DLI procedure to reduce the amount of cancer.
The same person who donated their stem cells to you donates lymphocytes for DLI. A healthcare provider collects the lymphocytes from your donor’s blood. Sometimes, providers freeze the lymphocytes. (They may do this step when your donor initially donates stem cells.)
To collect lymphocytes:
Here are the steps that occur during donor lymphocyte infusion:
Donor lymphocyte infusion may cause graft vs. tumor effect (GvT). When GvT occurs, donated T-cells find and get rid of cancer cells that remain after bone marrow or stem cell transplant. GvT is a sign that the donor’s immune system is fighting against the blood cancer.
It typically takes up to 30 minutes to receive your lymphocyte infusion. You may have several doses over a few weeks or months.
For years, if people had a relapse after bone marrow transplant (BMT), the only option was another bone marrow transplant. But a second BMT often comes with higher risks of complications. DLI can help cancer go into remission (when you don’t have blood cancer symptoms) — and it can do it without using drugs that suppress your immune system.
Your healthcare provider will watch for potential side effects from DLI. If they preserved the donor lymphocytes in dimethyl sulfoxide (DMSO), you might have a reaction to the preservative or notice a strange smell.
DLI can also cause some complications. You may develop graft vs. host disease (GvHD). When this happens, the immune cells from the donor (graft) see the cells in your body (host) as a threat and attack them. Symptoms of GvHD include:
Other risks of DLI include myelosuppression (bone marrow suppression). This condition can cause low blood cell count (anemia, leukopenia and low platelets). Leukopenia makes you more vulnerable to infections. Anemia may make you feel more tired and short of breath. Low platelets may result in bleeding.
If you develop GvHD, your healthcare provider may prescribe immunosuppressants. These medications help keep the donated lymphocytes from attacking your cells.
Leukopenia often gets better without treatment. If it doesn’t, your provider may recommend medications that stimulate the production of new white blood cells. Your provider can treat anemia and low platelets with transfusions. If your blood counts don’t recover, your provider may recommend another injection of donor blood stem cells to boost your blood counts.
Talk to your healthcare provider about when you can resume normal routines after DLI. You’ll have follow-up appointments and blood tests to track your response to DLI. Your provider also checks for symptoms of graft vs. host disease.
The donor lymphocyte infusion success rate varies depending on your health situation. Factors that affect the success of DLI include:
Donor lymphocyte infusion is a type of immunotherapy. During DLI, you receive an infusion of healthy T-cells from your donor. The healthy T-cells attack cancer cells left behind after bone marrow or stem cell transplant.
A note from Cleveland Clinic
You hoped cancer treatments were over after your stem cell transplant, but now you’re facing the news that cancer has returned. If you have a relapse after treatment for blood cancer, there is hope. An infusion of new healthy white blood cells may help. Lymphocytes from your stem cell donor may help strengthen your immune system and get rid of any remaining cancer cells after transplant.
Last reviewed by a Cleveland Clinic medical professional on 08/17/2023.
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