Donor Lymphocyte Infusion (DLI): How It Works, Benefits, Risks and Recovery
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is donor lymphocyte infusion?
Donor lymphocyte infusion (DLI) is a procedure that transfers healthy white blood cells called lymphocytes from a stem cell donor into a patient whose blood cancer returned after an allogeneic transplant. The donor T-cells attack leftover cancer cells, a graft-versus-tumor effect. Each infusion takes up to 30 minutes, and the main risk is graft-versus-host disease. [1][2]
What the research says
Giving DLI early, before a full relapse, is linked to longer survival. In 83 adults with acute leukemia or myelodysplastic syndrome, people treated at the first molecular sign of relapse lived markedly longer than those treated after an overt relapse: median survival was about 0.47 years in the overt-relapse group and was not reached in the early-treatment group (HR 0.15). (Angleitner et al., Annals of Hematology, 2026) [3]
Preventive DLI cut relapse but raised chronic GVHD. In 148 patients with refractory or relapsed acute myeloid leukemia, early preventive DLI lowered the 2-year relapse rate to 23.4% versus 48.8% with test-triggered DLI, while chronic graft-versus-host disease rose to 64.1% versus 40.5%. (Wu et al., Transplantation and Cellular Therapy, 2026) [4]
Following dosing recommendations matters for safety. In 83 patients given preventive or early DLI, 2-year overall survival was 80%; higher-than-recommended or earlier-than-recommended dosing raised severe acute GVHD to 53% (versus 34% overall) and was the main risk factor for poorer survival. (Velázquez et al., Haematologica, 2025) [5]
Key takeaways
DLI is a type of immunotherapy given after a donor (allogeneic) stem cell or bone marrow transplant. [1]
The lymphocytes come from the same person who donated your stem cells. [1]
It is used for relapse, for mixed chimerism, and sometimes before relapse when tests show early warning signs. [1][2]
The infusion itself is quick, but several doses may be given over weeks or months. [1]
The biggest risk is graft-versus-host disease (GVHD); low blood counts can also occur. [1]
What is donor lymphocyte infusion?
Donor lymphocyte infusion is a procedure that moves healthy white blood cells from a donor into a recipient's blood to help the immune system destroy cancer cells. [1] Lymphocytes are the white blood cells that help your body fight infections and cancer.
DLI is used after a transplant that relied on donor cells. It helps when blood cancer comes back, or when there is a high chance it will. [1]
Because DLI uses the immune system to fight cancer, it is a form of immunotherapy. [1]
How does donor lymphocyte infusion fight cancer?
Donor lymphocyte infusion fights cancer through the graft-versus-tumor effect, in which donor T-cells recognize and destroy cancer cells that survived the transplant. [1] Doctors see this effect as a sign that the donor's immune system is working against the blood cancer. [1]
Researchers have long known that the strength of this effect depends on the disease, its stage, how closely the donor matches, and how many donor cells are already in the marrow. [7]
What conditions are treated with donor lymphocyte infusion?
Donor lymphocyte infusion treats blood cancers that relapse after a donor blood or bone marrow stem cell transplant. [1]
Condition | Learn more |
Acute myeloid leukemia (AML) | |
Chronic lymphocytic leukemia (CLL) | |
Chronic myeloid leukemia (CML) | — |
Myelodysplastic syndromes (MDS) | — |
Multiple myeloma | — |
Non-Hodgkin lymphoma | |
Graft-versus-host disease (a main risk of DLI, not a condition it treats) | — |
Source: [1]
What is mixed chimerism, and why does it lead to DLI?
Mixed chimerism means your bone marrow holds a mix of your own cells and your donor's cells after transplant. [1] This mix raises the chance that the cancer will come back.
DLI pushes the marrow toward being fully donor-made, which helps the transplant do its job. [1]
What are the three ways donor lymphocyte infusion is used?
Donor lymphocyte infusion is used in three ways: to prevent relapse, to act on early warning signs, or to treat a relapse that has already happened. [2]
Type of DLI | When it is given | Goal |
Prophylactic (preventive) | To high-risk patients who are still in remission | Lower the chance of relapse [2][4] |
Pre-emptive | When tests find tiny traces of cancer (measurable residual disease) or mixed chimerism | Stop a relapse before it shows up in the blood [2][3] |
Therapeutic | After the cancer has clearly come back | Bring the cancer back into remission [2][3] |
Expert panels note that most evidence for these approaches comes from past patient records and expert agreement rather than large trials. [2]
How should you prepare for donor lymphocyte infusion?
You prepare for donor lymphocyte infusion with a physical exam, a symptom review and a set of tests ordered by your care team. [1]
Test | Why it is done |
Bone marrow biopsy | A pathologist checks if cancer cells remain [1] |
Complete blood count (CBC) | Measures red cells, white cells and platelets [1] |
Kidney function tests | Checks how well the kidneys are working [1] |
Liver function tests | Checks how well the liver is working [1] |
If the biopsy shows a high level of cancer cells, you may need chemotherapy first to shrink the cancer before DLI. [1]
How are lymphocytes collected from the donor?
Lymphocytes are collected from the same person who donated your stem cells, using a blood-filtering process called apheresis. [1] Sometimes the cells are frozen, and this can be done at the time of the first stem cell donation. [1]
A provider places a thin, flexible tube (catheter) in a vein in the donor's arm.
Blood flows into a machine that separates the mononuclear cells, which contain the lymphocytes.
The rest of the blood returns to the donor through a vein in the other arm. [1]
What happens during donor lymphocyte infusion?
During donor lymphocyte infusion, the donor's lymphocytes flow through a catheter into your bloodstream, much like a blood transfusion. [1]
Your provider places a catheter in your arm or chest.
The donor lymphocytes travel through the catheter into your blood.
Your provider removes the catheter.
If you have a central line (central venous catheter), it is flushed or may be removed. [1]
How long does donor lymphocyte infusion take?
A donor lymphocyte infusion usually takes up to 30 minutes. [1] You may receive several doses over a few weeks or months. [1]
What are the benefits of donor lymphocyte infusion?
The main benefit of donor lymphocyte infusion is that it can put blood cancer back into remission without a second transplant. [1]
In the past, a second bone marrow transplant was often the only option after relapse, and it carries a higher risk of complications. [1]
DLI can bring the cancer into remission without drugs that suppress the immune system. [1]
What are the risks and side effects of donor lymphocyte infusion?
The main risk of donor lymphocyte infusion is graft-versus-host disease (GVHD), in which donor immune cells see your body's healthy cells as a threat and attack them. [1]
Complication | What you may notice | How it is treated |
Graft-versus-host disease | Skin rash, diarrhea, nausea, vomiting, yellowing of the skin or eyes (jaundice) | Immunosuppressant medicines [1] |
Low white blood cells (leukopenia) | More frequent infections | Often improves on its own; medicines can boost white cell production [1] |
Low red blood cells (anemia) | Tiredness, shortness of breath | Blood transfusions [1] |
Low platelets | Easy bleeding or bruising | Platelet transfusions [1] |
Reaction to DMSO preservative (frozen cells only) | A reaction to the preservative or a strange smell | Watched closely by your care team [1] |
Low blood counts are part of a broader problem called myelosuppression, or bone marrow suppression. [1] If counts do not recover, your team may give another dose of donor blood stem cells. [1]
Will donor lymphocyte infusion work for me?
Whether donor lymphocyte infusion works depends on your type of cancer, its stage and your overall health. [1][6]
Factor | Why it matters |
Cancer stage | More advanced cancer is harder to control [1] |
Type of blood cancer | Responses are best in CML, followed by lymphomas, multiple myeloma and acute leukemias [6] |
Immune system health | DLI depends on a working donor immune response [1] |
Transplant type | The donor match and transplant approach affect results [1] |
Chemotherapy before DLI | Lowering the cancer burden first can help [1] |
Timing | Treating at early molecular relapse is linked to better survival than treating overt relapse [3] |
In one study of lymphoid cancers, DLI produced lasting remissions in low-grade lymphoma and mantle cell lymphoma, while aggressive lymphomas responded poorly. [8]
What is recovery like after donor lymphocyte infusion?
Recovery after donor lymphocyte infusion involves regular follow-up visits and blood tests to track your response and watch for graft-versus-host disease. [1] Ask your care team when you can return to your normal routine. [1]
When should you call your doctor after donor lymphocyte infusion?
Call your healthcare provider right away after donor lymphocyte infusion if you have a fever, bleeding, shortness of breath or any symptom of graft-versus-host disease. [1]
Seek urgent care if you have trouble breathing, heavy bleeding, or a high fever with chills — low white blood cell counts make infections more likely.
Donor lymphocyte infusion at a glance
Question | Short answer |
What is it? | An infusion of donor lymphocytes (white blood cells) [1] |
Who donates? | The same person who gave your stem cells [1] |
Why is it given? | Relapse, mixed chimerism or early signs of relapse [1][2] |
How long is each session? | Up to 30 minutes [1] |
How many doses? | Often several, over weeks or months [1] |
Main benefit | Graft-versus-tumor effect; remission without a second transplant [1] |
Main risk | Graft-versus-host disease [1] |
Conclusion
Learning that blood cancer has returned after a transplant is hard news. Donor lymphocyte infusion offers a real option: your donor's healthy immune cells are given back to find and clear the cancer cells left behind. [1] It is quick to receive, avoids a second transplant for many people, and works best when started early. Your transplant team will weigh its benefits against the risk of graft-versus-host disease and decide whether it fits your situation.
Keep learning with Rinnit. Explore our guides on acute myeloid leukemia, immunotherapy side effects and bone marrow failure, and bring your questions to your next transplant appointment.
FAQ
Is donor lymphocyte infusion a type of immunotherapy?
Yes. Donor lymphocyte infusion is a type of immunotherapy in which healthy donor T-cells are given to attack cancer cells left behind after a stem cell or bone marrow transplant. [1]
Who donates the cells for donor lymphocyte infusion?
The same person who donated your stem cells donates the lymphocytes. The cells are collected from the donor's blood and are sometimes frozen at the time of the original stem cell donation. [1]
How long does a donor lymphocyte infusion take?
Each infusion usually takes up to 30 minutes. You may need several doses spread over a few weeks or months. [1]
What are the side effects of donor lymphocyte infusion?
The main side effect is graft-versus-host disease, which can cause rash, diarrhea, nausea, vomiting and jaundice. Low blood counts can also lead to infections, tiredness and bleeding. [1]
Is donor lymphocyte infusion better than a second transplant?
A second bone marrow transplant often carries a higher risk of complications. Donor lymphocyte infusion can bring blood cancer into remission without a second transplant and without immune-suppressing drugs. [1]
What is the success rate of donor lymphocyte infusion?
The success rate varies with the cancer stage, the type of blood cancer, immune health, transplant type and whether chemotherapy is given first. Responses are generally best in chronic myeloid leukemia. [1][6]
What is mixed chimerism?
Mixed chimerism means your bone marrow contains both your own cells and your donor's cells after transplant. It raises relapse risk, and DLI helps make the marrow fully donor-made. [1]
When should I call my doctor after DLI?
Call your provider if you develop a fever, bleeding, shortness of breath or any symptom of graft-versus-host disease. [1]
How many donor lymphocyte infusions will I need?
Some people need only one infusion, while others get several doses. Doses are often spaced weeks apart so your team can watch for side effects such as graft-versus-host disease.
How is a donor lymphocyte infusion given?
The cells are given through a vein, much like a blood transfusion. Your team will tell you whether you can go home the same day.
External resources
Related Reading
Allogeneic Stem Cell Transplant: Process, Risks and Recovery explains donor stem cell transplants.
References
Cleveland Clinic. Donor Lymphocyte Infusion: Procedure, Purpose & Benefits. Cleveland Clinic. Last updated August 17, 2023. https://my.clevelandclinic.org/health/treatments/10343-donor-leukocyte-infusion
Pagliuca S, Schmid C, Santoro N, et al. Donor lymphocyte infusion after allogeneic haematopoietic cell transplantation for haematological malignancies: basic considerations and best practice recommendations from the EBMT. Lancet Haematol. 2024;11(6):e448-e458. PMID: 38796194. https://doi.org/10.1016/S2352-3026(24)00098-X
Angleitner AC, Maulhardt M, Treiber H, et al. Timing of donor lymphocyte infusion after relapse following allogeneic hematopoietic cell transplantation: a retrospective single-center analysis. Ann Hematol. 2026;105(6):297. PMID: 42215652. https://doi.org/10.1007/s00277-026-07090-1
Wu N, Yan CH, Kong J, et al. Prophylactic Versus Preemptive Donor Lymphocyte Infusion in Refractory/Relapsed AML Post-Allogeneic Transplant: A Retrospective Comparative Study. Transplant Cell Ther. 2026;32(3):302.e1-302.e10. PMID: 41173214. https://doi.org/10.1016/j.jtct.2025.10.029
Velázquez GF, Weller JF, Rubeck A, et al. Prophylactic and pre-emptive donor lymphocyte infusion in patients with acute myeloid leukemia and myelodysplastic syndrome: validation of current recommendations and proposal of a modified outcome assessment. Haematologica. 2025;110(10):2293-2304. PMID: 40270206. https://doi.org/10.3324/haematol.2024.287206
Deol A, Lum LG. Role of donor lymphocyte infusions in relapsed hematological malignancies after stem cell transplantation revisited. Cancer Treat Rev. 2010;36(7):528-538. PMID: 20381970. https://doi.org/10.1016/j.ctrv.2010.03.004
Kolb HJ. Graft-versus-leukemia effects of transplantation and donor lymphocytes. Blood. 2008;112(12):4371-4383. PMID: 19029455. https://doi.org/10.1182/blood-2008-03-077974
Russell NH, Byrne JL, Faulkner RD, et al. Donor lymphocyte infusions can result in sustained remissions in patients with residual or relapsed lymphoid malignancy following allogeneic haemopoietic stem cell transplantation. Bone Marrow Transplant. 2005;36(5):437-441. PMID: 15980879. https://doi.org/10.1038/sj.bmt.1705074
Medical disclaimer
This article is for general education and does not replace advice from your doctor or transplant team. Decisions about donor lymphocyte infusion depend on your diagnosis, transplant history and overall health. If you have urgent symptoms, contact your care team or local emergency services right away.
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