Abstract
Granulocyte transfusions have been advocated for the treatment of severe, progressive infections in neutropenic patients who fail to respond to antimicrobial agents and recombinant hematopoietic growth factors. We conducted the current study to evaluate the safety and efficacy of granulocyte transfusion therapy in patients with neutropenia-related infections. To mobilize granulocytes, healthy normal donors were stimulated with G-CSF 300ug SC dexamethasone 8mg po prior to leukapheresis. Before granulocyte transfusion, recipients were given hydrocortisone and pheniramine. Twenty-nine patients with severe neutropenia-related infections unresponsive to appropriate antimicrobial agents received a total of 36 sessions of granulocyte transfusions (total transfusion number = 148). Among these, 17 sessions were done with preirradiated leukapheresis products. 22 of 36 sessions (61.1%) responded with resolution of neutropenic fever, and side effects, mostly urticaria, were noticed in 13 sessions (36.1%), including 3 cases of peri-transfusion mortality. ANC increment(1495 vs 526), mean duration of antibiotic use (20.8 vs 34.3) and neutropenia (24.0 vs 35.9) were significantly different between responders and non-responders (p = 0.042, 0.058 and 0.043 respectively). Number of transfusion, granulocyte dose, age and irradiation were not significantly different between the 2 groups. We conclude that granulocyte transfusion therapy was useful and safe when the severity of infection and the host’s immunodeficiency make any other antimicrobial treatment ineffectual. TableTreatment OutcomeResponderNon-responderP ValueNo. of session22 (61.1%)14 (38.9%)Mean prior duration ofAntibiotics20.8 ± 12.434.4 ± 26.1P = 0.043Neutropenia24.0 ± 12.435.9 ± 24.2P = 0.058G-CSF11.6 ± 7.918.5 ± 12.9n.s.Irradiation (+/−)12/105/9n.s.No. of transfusion (mean)3.8 ± 1.44.6 ± 6.3n.s.ANC increment (mean)1495 ± 1564526 ± 646P = 0.042Granulocyte dose (1010 cell/kg)5.4 ± 1.66.0 ± 2.9n.s.n.s., not significant.
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