Clinical Experience of Granulocyte Transfusion Therapy in Pediatric Patients for Management of Neutropenia-related Infections in a Tertiary Care Center in India

Abstract

Introduction: In neutropenic patients bacterial and fungal infections are a major cause of morbidity and mortality, especially in hematological malignancies and post-hematopoietic stem cell transplantation. We present here a single institution experience with the use of granulocyte transfusions in children with severe neutropenic sepsis. Material and methods: This is a retrospective analysis of 48 children who received a total of 120 granulocyte transfusions following mobilization with colony-stimulating growth factor (G-CSF) and dexamethasone. Results: Favorable response was seen in 41.6% of the children without any major adverse effects in donor or recipient. Conclusion and clinical significance: Granulocyte transfusions hence may be a useful adjunct to antimicrobials and growth factors in neutropenic sepsis refractory to conventional antimicrobials.

Navigating the neutropenic abyss with granulocyte transfusions: Retrospective single‐center analysis of effectiveness and safety in India

“…In healthy individuals, G‐CSF causes a rapid dose‐dependent increase in the neutrophil count within 2 h, peaking at approximately 12 h, because of the rapid release of neutrophils from the marrow storage pool into blood. Mobilization with both G‐CSF and corticosteroids, in addition to increasing the neutrophil yield, upregulates the expression of genes encoding multiple toll‐like receptors and induces a response against microbes, thereby causing donor cells to produce large quantities of interleukin IL‐8, which in turn increases the antimicrobial activity of the transfused donor granulocytes 1 …”

“…Mobilization with both G-CSF and corticosteroids, in addition to increasing the neutrophil yield, upregulates the expression of genes encoding multiple toll-like receptors and induces a response against microbes, thereby causing donor cells to produce large quantities of interleukin IL-8, which in turn increases the antimicrobial activity of the transfused donor granulocytes. 1 In this study, both dexamethasone and G-CSF were used for granulocyte mobilization in donors. A significant increase in post-mobilization WBC count of the donor was observed (P < .001).…”

“…Patients diagnosed as having hemato‐lymphoid malignancies receive myelosuppressive chemotherapy, which is an aggressive treatment. Neutropenia is the most frequent adverse effect of this aggressive treatment 1‐3 . Despite the application of modern antimicrobial therapy and hematopoietic growth factors, such as the granulocyte colony‐stimulating factor (G‐CSF), prolonged episodes of severe neutropenia (absolute neutrophil count [ANC] < 0.5 × 10 9 /L) predispose patients to bacterial and fungal infections that could be occasionally fatal 4‐6 .…”

“…Neutropenia is the most frequent adverse effect of this aggressive treatment. [1][2][3] Despite the application of modern antimicrobial therapy and hematopoietic growth factors, such as the granulocyte colony-stimulating factor (G-CSF), prolonged episodes of severe neutropenia (absolute neutrophil count [ANC] < 0.5 Â 10 9 /L) predispose patients to bacterial and fungal infections that could be occasionally fatal. [4][5][6] This is particularly crucial in the current scenario of multidrug-resistant infections and in a setting with higher incidence of fungal infections.…”