10343 Donor Leukocyte Infusion

Overview

Donor leukocyte infusion (DLI) is a specialist treatment given after some stem cell transplants. It gives you extra white blood cells from the same person who donated your stem cells. White blood cells, called lymphocytes, are part of your immune system — your body's defence against infection and disease. In DLI, these donor cells may help your immune system fight cancer cells that have come back or help strengthen the donor immune effect. DLI is not a new transplant. It is an infusion through a vein, given by a transplant team.

No. DLI is a specialised procedure used in transplant centres for selected patients. It is not a routine treatment for most people.

Symptoms

Common symptoms

• Many people have no symptoms right after the infusion itself.
• Fever or feeling unusually unwell can be a sign of infection or a reaction.
• A new rash, skin redness, or itching may be an early sign of graft-versus-host disease (GVHD).
• Diarrhea, stomach cramps, nausea, or vomiting can occur.
• Yellowing of the eyes or skin, dark urine, or pale stools can be signs of liver problems.
• Feeling very tired, weak, or short of breath can be linked to low blood counts.
• Easy bruising, nosebleeds, or bleeding gums can be signs of low platelets.
• Mouth sores or a sore mouth can make eating and drinking difficult.

Symptoms in children

• Children may not be able to describe symptoms, so watch for behaviour changes.
• Watch for fever, poor feeding, fewer wet nappies, or dehydration.
• Irritability, sleepiness, or lack of energy can be important signs.
• A new rash, diarrhea, or mouth sores should be reported to the transplant team.
• Children may need extra help with hand hygiene and avoiding people who are unwell.

Symptoms in older adults

• Older adults may become dehydrated or confused more quickly.
• Watch for falls, weakness, dizziness, or a sudden change in thinking.
• Fever may be less obvious, so any new illness or unusual tiredness matters.
• Older adults may have more risk from infections and should report symptoms early.
• Ask the team about extra support at home if daily tasks become harder.

Causes

Main causes

• DLI is not caused by an illness. It is a planned treatment. The main reasons it is used include:
• Blood cancer has come back after a donor stem cell transplant, also called relapse.
• Mixed chimerism — a mix of your own cells and donor cells — when more donor immune cells may help.
• Some cases of poor graft function or graft failure, where donor cells are not working well enough.
• To boost the donor immune effect against cancer cells in selected patients.

Risk factors

• Having active or previous graft-versus-host disease (GVHD).
• Having an infection around the time of DLI.
• Older age or frailty, which can make complications harder to manage.
• Problems with the liver, kidneys, lungs, or heart.
• A big difference between donor and recipient tissue types.
• Receiving a high number of donor cells or more than one DLI, as advised by the team.

When to see a doctor

See a doctor urgently if:

• Fever, chills, or feeling suddenly very unwell.
• A new rash, skin peeling, blistering, or severe itching.
• Diarrhea, vomiting, or stomach pain that is getting worse.
• Yellow eyes or skin, dark urine, or pale stools.
• Bruising or bleeding that is new or unusual for you.
• Shortness of breath, chest pain, or swelling of the face or throat.
• Confusion, dizziness, fainting, or a sudden change in behaviour.
• Much less urine than usual, fast weight gain, or swelling.

Book a routine appointment if:

• Scheduled blood tests and clinic visits after DLI.
• Mild tiredness that is not getting worse.
• Questions about your medicines, diet, or activity level.
• Vaccination advice after transplant.
• Emotional worries, sleep problems, or anxiety that are affecting daily life.
• Planning travel or returning to work, school, or group activities.

Diagnosis

DLI is not a condition that is diagnosed. Instead, your transplant team assesses whether DLI is right for you. They review your cancer status, your blood counts, how well donor cells have taken over, your organ function, and whether you have infections or GVHD. They also explain the possible benefits and risks and ask for your consent before treatment.

Tests that may be done

• Blood tests to check blood counts, liver and kidney function, and infection markers.
• Bone marrow tests, such as a biopsy or aspirate, to check for cancer cells.
• Chimerism testing to see how much of your blood and immune system comes from the donor.
• Imaging scans, such as a CT scan or PET scan, if needed.
• Tests to screen for infections before treatment.
• Heart and lung checks if your team thinks they are needed.
• Donor cell checks and tissue matching information from your transplant records.

What to expect at your appointment

You will usually have clinic visits and blood tests before DLI. The team will explain the plan, benefits, and risks, and you will sign a consent form. The infusion is given through a vein, often using a central line — a thin tube placed into a large vein. You will be monitored during and after the infusion. Most people do not need to stay in hospital for a long time, but this depends on your team's plan.

Treatment

DLI is given by a specialist transplant team. The donor white blood cells are collected from the original donor, checked, and then infused into your bloodstream through a vein. The aim is to boost the donor immune response. Your team will decide the timing and number of infusions based on your situation. You will have regular follow-up to watch for GVHD, infection, and changes in blood counts.

Self-care at home

• Follow your team's advice on avoiding infections, including hand washing and avoiding crowds when your immune system is weak.
• Take all prescribed medicines exactly as your team tells you. Do not start, stop, or change any medicine without asking them.
• Check your temperature as advised and report fever right away.
• Drink enough fluids, especially if you have diarrhea, vomiting, or a fever.
• Rest when you need to, and do gentle activity if your team says it is safe.
• Keep a simple diary of symptoms, temperatures, and bowel changes to share with your team.
• Ask before having any vaccine, travel, dental work, or new supplement.
• Use sunscreen and protect your skin if you are outdoors.

Medical treatments

The main treatment is the donor leukocyte infusion itself. Your team may also use medicines to prevent or treat GVHD, infections, or low blood counts. They may give fluids, blood products, or nutrition support if needed. These decisions are made by your transplant team based on your test results and symptoms. You will have regular blood tests and clinic visits to guide care.

When is surgery considered?

DLI is not surgery. It is given as an infusion through an intravenous line — a thin tube into a vein. Sometimes a central line is used. The infusion usually takes a short time, and you will be watched for reactions.

Living with this condition

After DLI, life often centres on clinic visits, blood tests, and watching for symptoms. Keep your team's contact details close. Plan rest into your day and ask for help with shopping, childcare, or housework if you need it. Avoid people with colds, flu, or stomach bugs when possible. Follow your team's advice about work, school, and social activities, because your immune system may be weak for a time.

Lifestyle tips

• Wash your hands often and ask visitors to do the same.
• Avoid sharing cups, towels, or toothbrushes.
• Stay away from people who are clearly unwell, and avoid crowded places if your team advises it.
• Do not smoke, and avoid second-hand smoke.
• Keep up gentle movement, such as short walks, if your team says it is safe.
• Protect your skin from sunburn.
• Ask your team before gardening, swimming, or caring for pets, as some activities carry infection risk.
• Keep a current list of your medicines and allergies.

Diet and exercise

Food safety matters after transplant. Wash fruit and vegetables well, cook meat and eggs thoroughly, and avoid unpasteurised dairy and undercooked foods unless your team says otherwise. Ask to see a dietitian if you have mouth sores, nausea, diarrhea, or weight loss. Gentle exercise, like walking, can help your mood and strength, but avoid strenuous activity if your blood counts are low or you feel very tired. Your team can help you set safe limits.

Mental health and emotional wellbeing

It is normal to feel anxious, frightened, or worn down after a transplant and DLI. You may worry about relapse, GVHD, infections, or the future. These feelings can affect sleep, appetite, and relationships. Talk to your team — they can connect you with a psychologist, counsellor, or social worker. If you feel you may harm yourself or are in crisis, call your local emergency number or a local crisis support line right away.

Prevention

DLI itself cannot be prevented because it is a planned treatment. Some complications can be lowered by careful donor selection, screening for infections, close monitoring, and following your team's advice on infection control and medicines. Your team will weigh the possible benefits against the risks before recommending DLI.

Vaccines

After a stem cell transplant, your team will plan any needed vaccines once your immune system has recovered enough. Timing is based on your blood tests and treatment history. Always ask your team before having any vaccine, especially a live vaccine. Do not arrange vaccines on your own.

Screening programmes

Donors are screened for infections before their cells are used. You will also be screened for infections before DLI. After treatment, regular blood tests and clinic visits help your team spot GVHD, infection, or low blood counts early.

Complications

If left untreated

• Graft-versus-host disease (GVHD) that is not treated can damage the skin, liver, or gut and make you very unwell.
• Infections can become serious quickly when the immune system is weak.
• Low blood counts can lead to anaemia, bleeding, or a higher risk of infection.
• The cancer may continue to grow if the DLI does not work well enough, and other treatment may be needed.
• Organ problems, dehydration, or severe diarrhea can worsen without prompt care.

Long-term outlook

DLI can help some people go into remission or strengthen the donor immune effect against cancer. Results vary, and DLI carries real risks, especially GVHD and infection. Your team will watch you closely and treat problems early. Many people are helped by DLI, and support is available throughout your care. It is okay to ask your team about your outlook and what to expect.

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