Background
Invasive Fusarium infection is relatively refractory to available antifungal agents (AFAs). Invasive fusariosis (IF) occurs almost exclusively in the setting of profound neutropenia and/or systemic corticosteroid use. Treatment guidelines for IF are not well established, including the role of granulocyte transfusions (GTs) to counter neutropenia.
Study Design and Methods
We conducted a systematic review, identifying IF cases where GTs were used as adjunctive therapy to AFAs and also report a single-center case-series detailing our experience (1996-2012) of all IF cases treated with AFAs and GTs. In the systematic review cases, GTs were predominantly collected from non-stimulated donors, whereas, in the case-series, they were universally derived from dexamethasone/G-CSF-stimulated donors.
Results
Twenty-three patients met inclusion criteria for the systematic review and 11 for the case-series. Response rates post-GTs were 30% and 91% in the review and case-series, respectively. Survival to hospital discharge remained low at 30% and 45%, respectively. Ten patients in the systematic review and 3 in the case-series failed to achieve hematopoietic recovery and none of these survived. In the case-series, donor-stimulated GTs generated mean ‘same-day’ neutrophil increments of 3.35 ±1.24 ×109/L and mean overall posttransfusion neutrophil increments of 2.46 ± 0.85 ×109/L. Progressive decrements in neutrophil response to GTs in 2 cases were attributed to GT-related HLA alloimmunization.
Conclusion
In patients with IF, donor-stimulated GTs may contribute to high response rates by effectively bridging periods of neutropenia/marrow suppression. However, their utility in the absence of neutrophil recovery remains questionable.