How would you feel if you had a major treatment like a bone marrow transplant for blood cancer and thought, "Everything is fine now," and then you heard that the cancer had returned? It's really heartbreaking and very sad. But don't give up hope. Today we're talking about a special treatment that can help in situations like this. It's called DLI, which stands for Donor Lymphocyte Infusion.
Simply put, what is DLI?
Okay, let's put this simply. Lymphocytes are a type of white blood cell in your blood. They're like the soldiers in our bodies. They're a major part of our immune system, fighting off foreign germs, infections, and cancer cells.
Now, DLI (Donor Lymphocyte Infusion) is a procedure where some of these lymphocytes are taken from the same healthy donor who previously donated your bone marrow (stem cells) and injected into your body. These new, healthy and strong 'soldiers' seek out and destroy any remaining cancer cells that may be hiding in your body. That is the main goal of this treatment.
In what cases is DLI treatment recommended?
Your doctor is most likely to tell you about this treatment if your blood cancer comes back (relapses) after a bone marrow transplant.
Here are some of the conditions that DLI treatment is commonly used for:
- Acute Myeloid Leukemia (AML)
- Chronic Lymphocytic Leukemia (CLL)
- Chronic Myeloid Leukemia (CML)
- Multiple Myeloma
- Myelodysplasia (MDS)
- Non-Hodgkin Lymphoma
Another thing is, sometimes after a bone marrow transplant, your body may have a mix of donor cells and your own old cells. We call this (mixed chimerism) . This also increases the risk of the cancer coming back. So, DLI can be done to turn all the cells in your body into cells from the donor.
How do you prepare for this treatment?
Before starting DLI treatment, your doctor will examine you carefully, discuss your symptoms, and order several tests.
- Bone marrow biopsy: A small sample of bone marrow is taken to check for any remaining cancer cells.
- Complete Blood Count (CBC): Checks the number of cells in the blood.
- Kidney and liver function tests.
If the biopsy shows that the level of cancer cells is very high, your doctor may decide to give you chemotherapy before DLI. This is to reduce the number of cancer cells and increase the success of the DLI treatment.
How are lymphocyte cells obtained from a donor?
This is a very special thing that happens. The donor who gave you life, that is, the donor who gave you bone marrow, also helps with this. A small tube (catheter) is inserted into a vein in his arm and some blood is taken. This blood goes through a special machine. What that machine does is separate out only the lymphocyte cells we need, and send the rest of the blood back to the body through a vein in the donor's other arm. This process is called apheresis . Sometimes, when you first donate bone marrow, some of these lymphocyte cells can be taken and frozen for later use.
How do you receive DLI treatment?
This feels like something as simple as giving you a saline solution.
1. A doctor or nurse will insert a small tube (catheter) into a vein in your arm or chest.
2. Then, the packet containing the lymphocyte cells separated from the donor is connected to that tube and injected into your blood.
3. This task takes about 30 minutes .
4. When the work is finished, the tube is removed.
Sometimes you can give several doses like this over a period of several weeks or months.
When new cells are introduced into the body in this way, one of the most important things is called the graft vs. tumor effect (GvT) . This means that these healthy cells (graft) from the donor seek out the remaining cancer cells (tumor) in your body, attack them, and destroy them. This is how the cancer disappears completely.
What are the benefits and risks of DLI treatment?
The main benefits of this
In the past, if the cancer came back after a bone marrow transplant, the only option was to have another bone marrow transplant. But the risk of complications was much higher with a second transplant. DLI is a good, low-risk way to put the cancer in remission without immunosuppressants.
Possible risks and complications
As with all treatments, there are some risks. Your medical team will monitor you closely for these.
| Complication | Description and symptoms |
|---|---|
| Graft vs. Host Disease (GvHD) | This is when the cells from the donor (graft) see your healthy body cells (host) as an enemy and attack them. Symptoms: diarrhea, yellowing of the skin (jaundice), nausea and vomiting, skin lesions or a rash. |
| Myelosuppression | This is a temporary decrease in bone marrow function, which can lead to a decrease in the number of blood cells. - Low red blood cells (Anemia): fatigue, shortness of breath. - Decreased white blood cells (Leukopenia): Increased risk of infections. - Low platelets: Increased risk of bleeding. |
What to do if complications arise?
Don't worry. There are treatments for all of this.
- If GvHD occurs: Your doctor will prescribe immunosuppressants .
- If your blood cells are low: Low white blood cells often go away on their own. If not, there are medications to treat them. Blood transfusions can be given if necessary to treat low red blood cells and platelets.
After treatment and about success
Talk to your doctor about how long it will take to get back to normal after treatment. You will need regular follow-up and blood tests.
The success of this treatment can vary from person to person. There are several factors that affect it:
- Cancer stage.
- The health of your immune system.
- The type of transplant performed previously.
- Whether or not chemotherapy was performed before DLI.
Most importantly: If you develop any symptoms of GvHD such as fever, unusual bleeding, difficulty breathing, diarrhea, skin rash, or any other unusual symptoms , notify your doctor or treating hospital immediately.
Is DLI an immunotherapy?
Yes, DLI is a type of immunotherapy . Because it involves giving your own immune system healthy immune cells (T-cells) from outside to help it fight cancer. It's really promising.
Take-Home Message
- DLI is a special treatment for blood cancers that recur after a bone marrow transplant.
- This uses cells called lymphocytes from the same healthy donor who donated your bone marrow in the first place.
- The aim of this is for these new cells to seek out and destroy remaining cancer cells in the body (GvT effect).
- The main risks are GvHD (Graft vs. Host Disease) and low blood cell counts, but these are treatable.
- This is a form of immunotherapy that offers hope without the high risks of a second bone marrow transplant.
- Talk to your doctor right away about any new symptoms or problems.
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