Treatment of neutropenia-related fungal infections with granulocyte colony-stimulating factor-elicited white blood cell transfusions: a pilot study

Dignani, María Cecilia; Anaissie, Elias; Hester, Jeane P.; O’Brien, Susan; Vartivarian, Shahe; Rex, John H.; Kantarjian, Hagop M.; Jendiroba, David; Lichtiger, Benjamin; Andersson, B.; Freireich, Emil J.

doi:10.1038/sj.leu.2400811

Cited by 148 publications

(87 citation statements)

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“…17 Recent studies of therapeutic granulocyte transfusions for neutropenic infections in patients with leukemia and/or undergoing HSCT have shown survival rates of 31-81%; in patients with invasive fungal infections, the survival rates range from 20-80%. These studies, summarized in Table 4, [1][2][3][4][5][6][18][19][20][21][22][23][24][25] vary in the definition of invasive fungal infections, the timing of initiating granulocyte therapy, the cell dose of granulocytes transfused, and the number of granulocyte doses given. One study was randomized, but only 60% of patients were actually neutropenic prior to receiving granulocytes, and 44% of patients randomized to the granulocyte arm received only one or two transfusions before neutrophil recovery.…”

Section: Discussionmentioning

confidence: 99%

Granulocyte transfusions in severe aplastic anemia: an eleven-year experience

Quillen¹,

Wong

Scheinberg

et al. 2009

Haematologica

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Section: Discussionmentioning

confidence: 99%

Granulocyte transfusions in severe aplastic anemia: an eleven-year experience

Quillen¹,

Wong

Scheinberg

et al. 2009

Haematologica

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“…Centrifuge leukapheresis yielded approximately 5.5 ϫ 10 10 neutrophils per transfusion. 12 The transfusions were given daily or on alternating days, depending on the availability of blood donors, after having been irradiated with 25 centigray. Most patients received 5-10 transfusions of leukocytes during the course of their infection.…”

Section: Donor Priming and Granulocyte Collectionmentioning

confidence: 99%

“…The donors' immune systems were primed and granulocyte specimens subsequently collected as described previously. 12 Briefly, the donors were given a single dose of dexamethasone (8 mg, orally) and G-CSF (5 g/kg body weight, subcutaneously) 24 hours before neutrophil specimens were collected. Centrifuge leukapheresis yielded approximately 5.5 ϫ 10 10 neutrophils per transfusion.…”

Section: Donor Priming and Granulocyte Collectionmentioning

confidence: 99%

“…11 In a prospective study at The University of Texas M. D. Anderson Cancer Center (MDACC; Houston, TX) of invasive fungal infections in patients with cancer, therapy with high-dose GTX from donors primed with recombinant granulocyte-colony-stimulating factor (G-CSF) was more successful. 12 In studies of neutropenic patients with candidemia, GTX was also shown to be beneficial. 13 However, the efficacy of high-dose donor GTX in high-risk patients receiving antifungal therapy for candidemia remains uncertain.…”

mentioning

confidence: 99%

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Impact of high‐dose granulocyte transfusions in patients with cancer with candidemia

Safdar

Hanna

Boktour

et al. 2004

Cancer

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BACKGROUNDThe efficacy and feasibility of donor granulocyte transfusion therapy (GTX) have changed considerably over the past four decades. The authors sought to determine the impact of high‐dose (approximately 5.5 × 1010 cells) GTX in patients with candidemia.METHODSThe authors' case–control retrospective analysis comprised 491 consecutive patients treated at The University of Texas M. D. Anderson Cancer Center (Houston,TX) from 1993 to 2000. The cohort included 29 patients with Candida species bloodstream infection who had received GTX and 462 who had not.RESULTSBoth groups were comparable in age, gender, APACHE II score, recent chemotherapy received, broad‐spectrum antibiotics, systemic corticosteroids, radiotherapy, intravascular catheter, and concordant antifungal therapy (P ≥ 0.1). The patients who received GTX compared with those who did not had a higher incidence of underlying leukemia (86% vs. 29%, P < 0.001), persistent neutropenia (59% vs. 18%, P < 0.001), non‐Candida albicans candidemia (Candida glabrata, 35%; Candida krusei, 31%: 90% vs. 67%, P = 0.01), and breakthrough invasive mycosis (62% vs. 23%, P < 0.001). Neutropenia was more prolonged in patients who received GTX (28 vs. 10 days, P < 0.001). Also, more of the patients who received GTX had received hematopoietic stem cell transplantations (28% vs. 13%, P = 0.03), exposure (within 4 weeks) to antifungals (79% vs. 38%, P < 0.001), and stays in critical care units (62% vs. 40%, P = 0.02). The overall attributable mortality rate for 25 evaluable recipients of GTX was 48% (n = 12), compared with 45% (n = 115) of 254 evaluable patients in the control group (P = 0.5). Of the 158 patients with leukemia, 25 (16%) had received GTX. In patients with leukemia, more of those who had received GTX experienced disseminated candidiasis (44% vs. 26%; P < 0.07) and persistent neutropenia (68% vs. 43%, P < 0.02), had candidemia that was more prolonged (> 72 hours, P < 0.02), and had more stays in critical care units (68% vs. 44%, P < 0.03). On the bases of a reduced multivariate model, a significantly increased risk of death was found for patients with hematopoietic stem cell transplantation (odds ratio [OR] = 2.51; 95% confidence interval [95% CI], 0.99–6.31; P < 0.05), for patients with persistent neutropenia (OR = 4.57; 95% CI, 1.99–10.47; P < 0.0003), and for patients with leukemia who also had prolonged candidemia (OR = 3.59; 95% CI, 1.61–7.98; P < 0.002), disseminated candidiasis (OR = 5.19; 95% CI, 2.17–12.42; P < 0.0002), or non‐C. albicans candidemia (OR = 5.02; 95% CI, 1.07–23.64; P < 0.04). In patients with leukemia, death was attributable to candidemia in 50% of the GTX recipients, compared with 59% of the non‐GTX patients who had received antifungal therapy alone (P = 0.4).CONCLUSIONSDespite the presence of multiple predictors of increased mortality, high‐dose GTX therapy in these high‐risk patients with cancer was associated with better than expected survival rates. Cancer 2004. © 2004 American Cancer Society.

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“…Granulocyte infusions may also be used as a bridge to recovery from neutropenia but data to support this practice is scant. In one study of neutropenic patients with hematologic malignancies and IFI refractory to treatment with amphotericin B, 15 patients received granulocyte transfusions from related donors and 8 of the 15 had favorable outcomes [119].…”

Section: Other Management Strategiesmentioning

confidence: 99%