Successful Treatment With Granulocyte Transfusion and Early Neutrophil Engraftment in Allogeneic Transplant Patients With Febrile Neutropenia: Does Granulocyte Transfusion Effect on Neutrophil Engraftment?

Abstract

Background: Febrile neutropenia is very severe and urgent early complication after bone marrow transplantation before engraftment. Infection delays engraftments in these periods. Aim: In this study we evaluated the effect and outcome of granulocyte transfusion on febrile neutropenia and neutrophil engraftment in patients receiving allogeneic transplantation. The reasons for the use of the granulocyte transfusion were prolonged febrile neutropenia episode. Methods: Between 2015-2017, 16 patients receiving allogeneic bone marrow transplantation (BMT) were treated with granulocyte transfusion at the time of febrile neutropenia before engraftment. Sixteen patients (9 AML, and 7 ALL) underwent allogeneic transplantation. Nine of them transplanted from match sibling donors, 1 from unrelated donor, and 6 from mismatch family donor (haploidentic transplantation). They had febrile neutropenia after transplantation, before engraftment. They were given antimicrobial therapy. Granulocyte was collected from unrelated and same blood groups donors. We started granulocyte transfusion for 3-4 days. Results: Mean infused granulocyte counts were 3 × 1010 (1.2-4.8 × 1010)/d, and about 15%-20% of transfused granulocyte was monocyte. Before the granulocyte transfusion, on the 12th to 19th days of transplantation, their neutrophil counts were 0.02-0.09 × 103/dL. Twenty-four hours after granulocyte transfusion, mean neutrophil counts were 0.7 × 103/dL (0.4-1.2 × 103/dL). Neutrophil counts were 2.2 × 103/dL (1.7-2.6 × 103/dL) after 48 hour. After 72 hours, neutrophil counts were 3.2 × 103/dL (2.0- 4.6 × 103/dL). After 4th days of granulocyte transfusion, neutrophil counts were normal level (>0.5 × 103/dL) in 12 patients, and less than normal level (<0.5 × 103/dL) in 4 patients. Conclusion: Granulocyte transfusions during the febrile neutropenia, helped to better overcome febrile neutropenia periods in allogeneic transplant patients before engraftment. In addition, granulocytes transfusion also may help early neutrophil engraftments. The useful effect of granulocyte transfusion on neutrophil engraftment may be cause of cytokine (G-CSF) injection to donor before collection of granulocyte. Increased cytokine (G-CSF–GM-CSF–IL-3) level of transfused neutrophil and monocyte can also effect the neutrophil engraftment.