Sometimes the disease for which a patient is transplanted comes back. This is called relapse.
For some, relapse is an expected event. Patients with multiple myeloma, for example, who were transplanted with their own stem cells, know that their disease will eventually return. The objective of the transplant is to prolong their life and slow the progression of their disease.
Patients who are transplanted for a disease other than cancer rarely have a recurrence of their disease.
How Big is the Risk of Relapse after Transplant?
Your risk of relapse depends on a number of factors:
- the type and stage of your disease prior to transplant
- the number of years since transplant
- the type of transplant you had
Although there is no magic number that defines when you can consider yourself cured, in general, the more years that have passed since your transplant, the greater the likelihood that you have been cured.
Treatment Options after Relapse
For many patients, there are treatment options if relapse occurs:
- A donor lymphocyte infusion (DLI), also called a donor leukocyte infusion, can put some patients back into remission.
- For others, another transplant may be an option.
- You may also have an opportunity to enroll in a clinical trial that is testing a new drug or other therapy.
You and your doctor should thoroughly examine your options, so you can make a choice that is right for you. Don't be afraid to get a second opinion from another medical expert. Different institutions sometimes have different treatment option to offer patients.
Donor Lymphocyte Infusion (DLI)
A donor lymphocyte infusion (DLI), sometimes called a donor leukocyte infusion, is a treatment option for some patients who relapse after a transplant using donor cells (an allogeneic transplant). It may also be offered to patients who have a high risk of relapsing after transplant.
Lymphocytes are a type of white blood cell that help defend the body against disease. When a bone marrow or stem cell donor’s lymphocytes are infused into a patient, they can kill cancer cells that remain after transplant.
To prepare for a DLI, lymphocytes are collected from the same person who provided the bone marrow or stem cells for transplant. The collection procedure is similar to that used to collect stem cells prior to transplant, but without the drugs that move the donor’s stem cells from the bone marrow into the bloodstream. (See the How Bone Marrow and Stem Cells are Collected section of our web site.)
Sometimes donor lymphocytes are available from the original stem cell collection and can be used for a DLI instead of doing another collection.
Typically, the donor’s lymphocytes are infused into the patient through a central venous line or port, although it is possible to infuse them directly into the patient’s vein as well. The procedure is usually done in the outpatient clinic.
The major complication after a DLI is graft-versus-host disease (GVHD). (See the Graft-versus-Host Disease section of our web site.) Up to 50 percent of patients develop acute graft-versus-host disease after a DLI. The risk varies depending on
• the number of lymphocytes infused into the patient
• whether the patient is on drugs that suppress the immune system
• whether the donor is related or unrelated
• how well the donor’s HLA type matches the patient
• whether the patient previously had GVHD
If a patient does not develop graft-versus-host disease after a DLI, a second DLI may be possible.
Donor lymphocyte infusions have been most successful in patients with chronic myelogenous leukemia who relapse after transplant. More limited success has been seen in patients with lymphoma, multiple myeloma or acute leukemia.