Single-donor granulocyte transfusions for improving the outcome of high-risk pediatric patients with known bacterial and fungal infections undergoing stem cell transplantation: a 10-year single-center experience

Abstract

Bacterial and fungal infections remain a significant cause of transplant-related mortality following allogeneic stem cell transplantation (SCT). Granulocyte transfusions (GTs) may reduce the neutropenic period after SCT and prevent further progression of the existing infection (that is, therapeutic GT) in addition to standard antibacterial and antifungal therapy. A retrospective analysis was performed on 28 consecutive pediatric SCT recipients who received at least one dose of GT between March 2003 and November 2013 at a single institution. All donors were conditioned with G-CSF+dexamethasone with harvest performed 12-18 h later. Indications for SCT were acute leukemia in 46% (13/28) and severe aplastic anemia in 21% (6/28). The main indications for GT were invasive fungal disease in 50%, bacterial infection in 21% and co-morbidities with predicted reduced tolerance to sepsis in 18% (5/28). The median number of GT was 6 (range 1-14) with a median dose of 3.56 × 10 10 granulocytes infused. The median increment in ANC was 1.06 × 10 9 /L and correlated with the granulocyte dose infused. Adverse reactions observed were mild and infrequent. Sixty-four percent of patients (18/28) are alive with only 2 of the 10 deaths being related to progression of infection. In addition there was a low overall incidence of grade 3-4 acute mucositis and a very low incidence (7%) of acute GvHD grade 3-4. Single-donor GTs afford protection to children undergoing SCT at additional risk of infection and may reduce the overall incidence of severe GvHD.

Cellular collection by apheresis

“…There is limited evidence in support of granulocyte transfusion therapy in neutropenic septic patients who are unresponsive to antimicrobial therapies. 6,7 In this procedure, a healthy donor is stimulated either with dexamethasone or growth factor (granulocyte-colony stimulating factor) or both followed by leukocytapheresis. 6 Technically, this differs from MNC collections in that a much darker product is targeted due to the proximity of granulocytes to red blood cells in the centrifuge bowl.…”

Granulocyte transfusions: A concise review for practitioners

“…In a 10-year single-center experience Nikolajeva et al report the data on 28 children who underwent allogeneic HCT and received GTX because they were considered to be at high risk of infection or had persistent infection at the time of transplant [70]. 18 patients survived, and only 2 deaths were caused by progression of infection.…”

Granulocyte Transfusions: A Critical Reappraisal

“…In Tables 1 and 2 the 20 retrospective [ [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and 13 prospective [37][38][39][40][41][42][43][44][45][46][47][48][49] studies on GTs are illustrated. These studies include hematologic patients with postchemotherapy neutropenia or severe aplastic anemia and have been carried out subsequently to the advent of G-CSF.…”

“…In particular, the resolution/ recovery from infection was reported as the outcome in 17 studies, including overall 379 patients, and varied from 36.7% to 92.6% [17][18][19]22,24,26,30,32,33,37,[39][40][41][42][43]46,48]. The mortality attributable to infection (or comparable outcomes such as day 28 or day 30 survival, which indirectly estimated the mortality related to the infection) was reported in 12 studies including 594 patients and ranged between 6.7% and 66.7% [20,21,23,25,[27][28][29]35,36,38,45,47]. In contrast to the generally encouraging appraisal in bacterial infections, results in patients with fungal infections were more heterogeneous, with some studies reporting low efficacy [20,39] or even detrimental effects [31].…”