ABSTRACT
Neutropenia-related fungal infections can be life-threatening despite antifungal therapy. We evaluated the role of recombinant granulocyte colony-stimulating factor (rG-CSF)-elicited white blood cell (WBC) transfusions in patients with neutropenia-related fungal infections. Adult patients with hematologic malignancies, absolute neutrophil counts (ANC) <500/microl and fungal infections refractory to amphotericin B, received daily transfusions of rG-CSF-elicited and irradiated WBC transfusions from related donors. Donors received 5 microg/kg/day of rG-CSF subcutaneously. Donors achieved a mean ANC of 29.4 x 10(3) per microliter. The mean yield of neutrophils per transfusion was 41 x 10(9) (range, 10-116). Fifteen patients received a median of eight transfusions (range, 3-16). Fourteen patients had received rG-CSF for a median of 12 days. The median ANC baseline was 20/microl. Eleven patients had favorable responses and eight of them remained free of infection 3 weeks after therapy. Favorable responses occurred among patients with better Zubrod performance status (median, 3 vs 4) and shorter duration of both profound neutropenia (median, 15 vs 25 days) and active infection (median, 8 vs 17 days). The mean 1- and 24-h post-transfusion ANCs were 594/microl (range, 98-1472/microl) and 396/microl (range, 50-1475/microl), respectively. Adverse reactions were observed in nine of 35 donors and in the recipients of six of 130 transfusions. rG-CSF-elicited WBC transfusions may be a safe and promising approach for treating neutropenia-related fungal infections.
Subject(s)
Granulocyte Colony-Stimulating Factor/therapeutic use , Leukocyte Transfusion , Mycoses/therapy , Neutropenia/microbiology , Neutropenia/therapy , Adolescent , Adult , Aged , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Blood Donors , Female , Granulocyte Colony-Stimulating Factor/adverse effects , Humans , Male , Middle Aged , Mycoses/etiology , Pilot Projects , Prospective StudiesSubject(s)
Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Antineoplastic Agents/therapeutic use , Bone Marrow Transplantation , Clinical Trials as Topic , Combined Modality Therapy , Humans , Immunologic Factors/therapeutic use , Interferon-alpha/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Oncogenes , Prognosis , Risk FactorsABSTRACT
We analyzed survival in 203 children with Philadelphia-chromosome-positive chronic myeloid leukemia (CML). Median survival was 4.1 years; average annual risk of death was 20%. These survival data are similar to those reported in adults. Because there is no possibility of long-term disease-free survival in children with CML with conventional therapies, the findings of this study suggest that bone marrow transplantation should be considered in these patients.