Granulocyte Transfusions Are Safe and Feasible in High-Risk Pediatric Allogeneic Transplant Patients

Abstract

<h3>Introduction</h3> Patients undergoing stem cell transplantation (SCT) are at high risk of bacterial and fungal infections prior to engraftment. Those with a significant infectious history are especially high-risk. Granulocyte transfusion (GT) may help prevent infectious complications during the pre-engraftment period, but feasibility and safety data on GT are limited in pediatric SCT patients. <h3>Objective</h3> We evaluated the safety and feasibility of volunteer-donor GT for pediatric SCT patients. <h3>Methods</h3> We retrospectively reviewed records of allogeneic SCT patients at UPMC Children's Hospital of Pittsburgh (Pittsburgh, PA) who received pre-engraftment GT from unrelated volunteers between August 2012 and October 2016. Granulocyte donors were ABO-matched and stimulated with oral corticosteroids. Patients received pretreatment with acetaminophen, diphenhydramine, and methylprednisolone before each infusion. <h3>Results</h3> Eleven patients (3 female) of median age 7.5 years (0.7 – 40.3) received a total of 53 GT (median 4 per patient). All patients had a history of bacterial and/or fungal infection (Table 1); 4 patients (36%) had received at least 1 prior allogeneic SCT. Mean cell dose per GT was 1.7 ± 0.7 × 10¹⁰. Mean rise in white blood cell (WBC) count after GT was 1 ± 1.6 × 10⁹, which significantly correlated with cell dose (Figure 1). Fever occurred during 4 GT (7.6%), and transient dyspnea occurred during 3 GT (5.7%). No severe reactions were reported. During the course of GT, blood cultures from 3 patients (27%) grew coagulase-negative Staphylococcus, and 1 of these patients developed acute-on-chronic bacterial pneumonia. Overall survival was 82% at 100 days and 64% at 365 days post-SCT. Infection-related mortality was only 9% (1 patient died of disseminated cytomegalovirus). <h3>Conclusions</h3> In a high-risk group of pediatric allogeneic SCT patients with prior infections, GT did not cause any serious complications, and infection-related mortality was low. Corticosteroid-stimulated volunteer donors provided adequate cell doses. GT appears safe and feasible in high-risk pediatric SCT patients, and it may be underutilized as adjunctive treatment for those with a history of serious infections. The efficacy of GT deserves further study.