The use of stimulated granulocyte transfusions to prevent recurrence of past severe infections after allogeneic stem cell transplantation

Abstract

Summary. The predictable neutropenia that follows allogeneic stem cell transplantation (ASCT) may be associated with recurrence of previous life-threatening infection. We describe nine patients with either previous invasive aspergillosis (IA) or considered to be at high risk of developing IA who underwent ASCT with prophylactic granulocyte transfusions. The study group, when compared with a control group, had a significant reduction in the incidence and duration of fevers (P < 0AE05) and maximum C-reactive protein (P < 0AE05). There were significantly fewer days of neutropenia (P < 0AE05). There was also radiological improvement of pulmonary infiltrates in four out of seven assessable patients. No serious toxicity was encountered in donors or recipients. We conclude that prophylactic granulocyte donations can be given safely, and that they significantly reduce the number of days of neutropenia. Further investigation is warranted to determine whether granulocyte donations can prevent the recurrence of IA in patients at risk of fungal infection.

Granulocyte transfusions in the G-CSF era. Where do we stand?

“…32,33,[55][56][57] What can be concluded from these recent studies that have employed G-CSF mobilised granulocytes?…”

“…58,59,[61][62][63][64][65] In more recent studies employing G-CSF mobilised GTX, the method of leucocyte compatibility testing have been variable and in some studies either not performed or not reported. 34,50,57 The use of a screening lymphocytotoxicity assay prior to the provision of four prophylactic GTX (from the same donor) to patients undergoing autologous stem cell transplantation was found to predict for lower neutrophil increments following the last two GTX. 33 However, these results were of borderline significance and in a study of GTX for neutropenic sepsis leucocyte incompatibility had no impact on granulocyte increments.…”

“…Firstly, by administering G-CSF-stimulated granulocytes measurable increments in the neutrophil count of up to 4510/ml 1 h following infusion may be achieved, 26,[32][33][34]45,57 and that elevated counts may persist for at least 24 h. 26,34,50,57 The increment achieved with each GTX shows some variability and the factors influencing the increments achieved are not clearly established. Surprisingly, in some studies, there was no clear correlation between the dose of neutrophils administered (either total dose or adjusted per kg body weight) and the subsequent neutrophil increment.…”

“…56 The definitive results of this study are awaited with interest. At our institution we have now employed prophylactic GTX in 22 patients with a previous history of fungal infection (two proven, four probable and 16 possible according to International Concensus Criteria 75 ), who are undergoing allogeneic stem cell transplantation 57 (and Robinson et al unpublished observations). According to this protocol, patients receive pretransplant antifungal therapy and then prophylactic liposomal amphotericin and GTX during the period of neutropenia following conditioning therapy.…”

“…73 Several groups have reported the use of prophylactic G-CSF primed GTX in patients undergoing allogeneic stem cell transplantation, 32,55,56 autologous stem cell transplantation 33 and patients with a prior history of fungal infection who are receiving an allogeneic bone marrow transplant. 57,74 The prophylactic GTX have been administered every 2-4 days employing friends and relatives of the recipient. Using such a strategy the number of days of neutropenia may be reduced relative to historical controls although neutropenia (defined as neutrophil count o0.5 Â 10 9 /l) is not entirely prevented.…”