Allogeneic lymphocyte infusions

CPT4 code

Name of the Procedure:

Allogeneic Lymphocyte Infusions (ALI)
Also known as: Donor Lymphocyte Infusions (DLI)

Summary

Allogeneic lymphocyte infusions involve the transfer of lymphocytes, a type of white blood cell, from a healthy donor to a patient. This procedure is typically used to strengthen the patient's immune system to fight off diseases such as cancer.

Purpose

Medical Condition: Used primarily for patients with certain types of blood cancers, such as leukemia, lymphoma, and myeloma.
Goals: Aim to enhance the body's immune response to residual cancer cells, potentially leading to their eradication or significantly reducing disease activity.

Indications

Patients who have undergone allogeneic stem cell transplantation but still have residual cancer cells.
Patients experiencing relapse after an allogeneic stem cell transplant.
Evidence of mixed chimerism, where both donor and recipient cells coexist, potentially increasing the risk of relapse.

Preparation

Pre-procedure Instructions: Patients may need to fast for a few hours before the infusion. They should inform their healthcare provider about any medications they are taking.
Assessments: Blood tests, imaging studies, and consultations with the transplant team to evaluate the patient's health and suitability for the infusion.

Procedure Description

Collection of Lymphocytes: Lymphocytes are collected from a compatible donor through a process called apheresis.
Preparation of Cells: The collected cells are processed and prepared for infusion.
Infusion: The patient receives these lymphocytes through an intravenous (IV) line. This process is similar to a blood transfusion.
- Equipment Used: IV line, apheresis machine for cell collection.
- Anesthesia or Sedation: Generally not required, but pre-medication to prevent reactions may be given.

Duration

The infusion itself typically takes a few hours.
The total process, including monitoring before and after, might take the better part of a day.

Setting

Performed in a hospital setting, specifically in the oncology or hematology unit.

Personnel

Hematologist/Oncologist
Transplant Specialist
Registered Nurses
Other supportive care staff (e.g., pharmacists, laboratory technicians)

Risks and Complications

Common Risks: Fever, chills, and allergic reactions.
Rare Risks: Graft-versus-host disease (GVHD), where donor cells attack the patient's tissues; infections; pulmonary complications.
Management: Medications to manage reactions and close monitoring before, during, and after the procedure.

Benefits

Enhanced immune response to fight residual cancer cells.
Improved chances of remission and long-term survival.
Benefits are typically noticed within weeks to months post-infusion.

Recovery

Post-procedure Care: Patients will be monitored for immediate reactions and side effects. Regular follow-up appointments are necessary.
Recovery Time: Variable, ongoing monitoring is vital, and patients might need supportive treatments.
Restrictions: Patients might need to avoid certain activities and manage medications as directed by their healthcare provider.

Alternatives

Chemotherapy/Radiotherapy: Standard cancer treatments that can be continued or adjusted.
Autologous Stem Cell Transplantation: Using the patient’s own cells, though not suitable for all cases.
Targeted Therapy or Immunotherapy: Can be considered depending on the patient's specific condition.

Patient Experience

During the Procedure: Likely to feel some discomfort due to the IV infusion but generally not painful. There may be pre-medication to reduce allergic reactions.
After the Procedure: Some fatigue, fever, or chills are possible. Pain management includes over-the-counter pain relievers and specific medications prescribed by the healthcare provider for severe symptoms. Comfort measures include rest, hydration, and communication with the healthcare team about any side effects experienced.