Analysis of Granulocyte Transfusions in Patients with Infections and Neutropenia: A Single Center Experience / 대한수혈학회지

BACKGROUND: Granulocyte transfusion therapy has been used as supportive care for patients with prolonged neutropenia after intensive chemotherapy or peripheral blood stem cell transplantation (PBSCT). Here, we investigated clinical factors of granulocyte transfusion therapy for neutropenic patients with infection to evaluate its efficacy and safety. METHODS: A retrospective analysis of 25 neutropenic patients treated with 99 granulocyte collection and granulocyte transfusion therapy from October 2011 to April 2016 at the National Cancer Center was conducted. Two groups, a count recovery group with a cut off of >1,000/µL and a no recovery group were compared and symptoms related with granulocyte transfusion were analyzed. RESULTS: Granulocyte collection and transfusions were performed in 99 procedures. After granulocyte transfusion therapy, 21 patients (84%) showed count recovery, whereas 4 patients (16%) had no response. Significant differences in pre-absolute neutrophil count (29/µL vs. 0/µL, P=0.048), duration of neutropenia before granulocyte transfusion (11 days vs. 26 days, P=0.011), and total number of granulocyte transfusion (2 times vs. 11 times, P=0.049) were observed between groups. Temporary symptoms related granulocyte transfusion were observed in seven patients (28%); however, all patients showed clinical improvement. The median of the single transfusion volume was 220 mL (200 to 397 mL) and the mean total granulocyte content was 4.92×10¹⁰. CONCLUSION: Granulocyte transfusion therapy is safe and effective for patient with life threatening neutropenia and infection, also considerable for early onset trial for granulocyte transfusion.

Granulocyte transfusions from G-CSF- and dexamethasone-stimulated healthy donors for treatment of patients with severe neutropenia-related infections / 대한내과학회지

BACKGROUND: Granulocyte transfusions have been used to treat severe, progressive infections in neutropenic patients who fail to respond to antimicrobial agents. Although corticosteroid or granulocyte colony-stimulating factor (G-CSF) were previously used separately to increase leukocyte counts in healthy donors, increasingly G-CSF and corticosteroids are used together, requiring the need to establish the efficacy of this mobilizing regime. METHODS: This prospective study evaluated the safety and efficacy of granulocyte transfusion therapy from donors stimulated with a combination of G-CSF and dexamethasone, in 27 patients with severe neutropenia-related infections. To mobilize granulocytes, healthy volunteer donors received G-CSF, 5 micro gram/kg subcutaneously 12-14 hr before leukapheresis, and dexamethasone, 3 mg/m2 intravenously 15 min before leukapheresis. RESULTS: Donor neutrophil counts were 5,723/micro L (range: 1,500~36,420) at baseline, 22,104/micro L (range: 9,700~41,300) before the injection of dexamethasone, 23,946/micro L (range: 10,900~42,100) immediately before leukapheresis, and 19,913/micro L (range: 9,100~36,300) after leukapheresis. Ninety-two leukapheresis procedures were performed with a mean yield of 7.88 10(10) granulocytes (range: 2.2~17.9 10(10)). The mobilizing agents were well tolerated in the donors. Of the patients, 16 (59.3%) showed favorable responses, whereas 11 (40.7%) had unfavorable responses. Adverse reactions to the therapy were arrhythmia in two patients (7.4%) and pulmonary edema in one patient (3.7%). Favorable responses were seen in 83.3, 76.9, and 45.5% of the patients from whom fungal, Gram-negative, and Gram-positive organisms were isolated, respectively. CONCLUSION: This study suggests that the combination of G-CSF and dexamethasone is an effective, well-tolerated regimen for mobilizing granulocytes from healthy donors, and that granulocyte transfusion therapy is useful for neutropenic patients, especially those with fungal or Gram-negative infections that are resistant to appropriate antimicrobial agents.