Donor Lymphocyte Infusion
For patients whose disease persists or recurs after a donor stem cell transplant, a donor lymphocyte infusion (DLI) may be given to try to control the disease. A DLI comes from your stem cell donor. Donor lymphocytes are white blood cells. They can have anti-tumor activity. DLI has been used in patients with leukemia, lymphoma, and multiple myeloma.
Your insurance company will be contacted to find out if lymphocyte collection and infusions are covered.
How it works
Lymphocytes are a type of white blood cell with many jobs. One job is to find and destroy foreign cells in the body. When donor lymphocytes are given to a patient, they seek out the remaining cancer cells and target them to be destroyed. This action is called graft-versus-tumor (GVT) effect.
Treatment
If DLI is right for you, your stem cell donor will be asked to donate some lymphocytes to be infused into your body. Once the donor agrees and is assessed, s/he will donate lymphocytes by apheresis. During this process, a portion of the lymphocytes in the donor's blood will be collected from a vein over 3 – 4 hours. The donor’s blood flows from a vein in one arm through the apheresis machine where the lymphocytes are collected. The blood flows back to the donor through a vein in the other arm. Enough donor lymphocytes can be collected for more than one DLI. Most often, enough cells are collected for about three infusions. The donor will still have enough cells to stay healthy.
Donor lymphocytes are infused through a vein. Most DLIs are done in the outpatient clinic. You should not need an overnight stay in the hospital. You could receive a total of 2-3 infusions. There would be three to four weeks between each infusion. This would depend on your response to the DLI.
After each infusion, we will check your progress and decide whether more infusions are needed. This could include physical exams and/or blood tests.
Risks
Side effects you may have on the day of DLI are fever, chills, hives, or shortness of breath after the infusion. You will be watched during and after the infusions in order to manage any possible side effects. Most people have very few side effects from the infusion.
It is likely that you may notice an unusual odor to your breath, skin, and urine for 1-2 days after the DLI. This unusual odor is sometimes described as garlic or creamed corn. The reason for this scent is a chemical used to preserve the cells called DMSO. You should drink lots of water after the DLI to help your body flush out any left over DMSO.
The DLI may also cause you to develop graft versus host disease (GVHD). GVHD is a reaction of the donor lymphocytes against your own tissue. It can produce damage to skin, liver, bowel, or other organs. GVHD might not develop right away, but can occur several months after the infusion. Mild GVHD is known to have anti-tumor benefits. If you develop moderate to severe GVHD, your doctor will provide treatment to try to help control it. Moderate to severe GVHD can be life threatening. It may not respond to treatment.
The infusions may also cause your own red cell, white cell, and platelet counts to drop to very low levels. This puts you at risk for infection or bleeding problems. If needed, you will receive blood or platelet transfusions. If needed, you could also receive stem cell growth factor (GM-CSF or G-CSF) to cause your bone marrow to make blood cells more quickly. Antibiotics can be given to treat infection.
Your doctors and nurses will check you often to see if any side effects occur. Medicines can be given to keep many of these side effects under control.
Benefits
You could have a response to the DLI. This is a slowing of the progress of disease or a remission of the disease. It is also possible that you might not have any response at all. Response and remission rates vary. They depend on your history, disease, and type of transplant. Your doctor will discuss your case with you.
Phone Numbers
Cancer Clinic Triage, Monday – Friday, 8:00 am – 5:00 pm (608) 265-1700
If you live out of the area, call 1-800-323-8942 and ask for the Cancer Clinics at extension 5-1700.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 02/15/2010
Copyright © 02/15/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6902
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