DLI Day

George went in for his DLI (donor leukocyte infusion) on Wednesday, December 14. We were under the impression that the purpose was to boost the percentage of George’s donor cells….to get the low counts back up with more donor cells. However, we were slowly realizing that wasn’t the case.

Waiting in the aphaeresis unit, while George was getting 250 ml of saline to hydrate him, we asked the nurse why George was only getting infused with T-cells (CD3 cells) when his percentage of those cells was 96% donor, yet his CD33-34 (myeloid cells) were now only FIVE PERCENT donor? Seems like they would want to give him a boost of THOSE cells!

CD3 (cancer/infection fighting cells still 96% donor cells
(CD33/ CD66) Myeloid cells plunged to only 5% donor

She replied that she didn’t know, but that she would send the doctor in to talk to us and answer our questions.

Getting George ready for his hydration infusion before his donor cells are infused
Getting hydrated

Dr. Ethan Mack came in to talk to us. He was extremely knowledgeable and could communicate what was going on so well! I think I get it now. I don’t like it, but I think I get it.

So, he said that the reason they are only giving T-cells is basically to fight any tumors or disease in the body. Yeah. Not because his donor cells might be weak, or his immune system might be too strong like Dr. Loren suggested to us. But they are operating under the assumption that there is some disease in George’s body. And by infusing more donor cells that would recognize leukemia cells that George’s cells don’t, they are hoping for a Graft vs Tumor situation (GVT).

I told him George had recently had a bone marrow biopsy and that it was clear, and Dr. Mack responded by saying basically “Well, yeah…but that’s just a small piece of bone and you have all this other bone in your body that wasn’t biopsied.”

So, I decided to research a little on my own, which is sometimes not a good idea. But what I learned is that years before, the only treatment option that offered relapsed bone marrow transplant patients hope of a cure was another bone marrow transplant. However, the risk of serious, life-threatening complications after a second BMT is great. One strategy of managing relapse, donor leukocyte infusion, might eliminate the need for a second BMT in some patients. Relapse?????

Donor lymphocyte infusion is the infusion in which lymphocytes from the original stem cell donor are infused, after the transplant, to augment an anti-tumor immune response or ensure that the donor stem cells remain engrafted. These donated white blood cells contain cells of the immune system that can recognize and destroy cancer cells.

The goal of this therapy is to induce a remission of the patient’s cancer by a process called the graft-versus-tumor effect (GVT). The donor T-cells can attack and control the growth of residual cancer cells providing the GVT effect. It is hoped that the donor leukocyte infusion will cause GVT and lead to a remission of the patients cancer. Patients might require standard chemotherapy, to reduce the amount of cancer cells they have prior to their donor lymphocyte infusion. Since Geog=rge showed no signs of disease before his DLI, he didn’t require any chemo, thank God.

So, to me…and of course, I could be wrong, what Dr. Mack was saying is that they were doing the DLI to achieve GVT. But one little sentence above – “to augment an anti-tumor immune response OR ensure that the donor stem cells remain engrafted” gives me some hope that this procedure really can be done just to “ensure that the donor stem cells remain engrafted.” That’s what I’m hoping for and that’s the assumption under which we are operating because Dr. Loren knows George’s situation better than Dr. Mack and we feel if she thought we should worry, she would tell us. She has always been straightforward with us. Although, she did mention a second bone marrow transplant at a previous visit, but said we are not there yet.

The nurse bringing the precious donor cells in for George
George was hydrated for about an hour prior to receiving his donor cells and for an hour afterwards.

Again, on this day, we were so moved by the selfless generosity of George’s anonymous donor. And so very grateful.

Also – George will NOT behaving his PICC line removed next month like we were told, he will NOT be starting his childhood vaccines next month and we will NOT be saying goodbye to Jessica, our home health nurse. She will still be coming weekly to draw labs. This has been very discouraging for George, especially the delay with the vaccines. Traveling abroad again is a major goal and it feels scary to do it unvaccinated. Anyway….

So, now we wait. Dr. Loren said we would know something in 4-6 weeks, as far and his chimerism numbers going up. George’s next appointment is January 11 and they will take more labs to check his numbers then.

Stay tuned….

For now, we will concentrate on enjoying the Christmas holiday with our family and loved ones, grateful for this past year and praying for many more to come.

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