To evaluate the role of prophylactic granulocyte transfusions during remission-induction chemotherapy for acute myelogenous leukemia (AML) we randomized 102 infected patients either to receive daily granulocyte transfusions when blood granulocytes fell below 0.5 x 10(9) per liter (54 patients) or not to receive them (48). Although the percentage of patients acquiring any infection was similar in the transfusion and control groups (46 and 42 per cent, respectively), granulocyte transfusions decreased the proportion of patients with bacterial septicemia (9 per cent of those with transfusions vs. 27 per cent of the controls; P = 0.01). Granulocyte transfusions did not reduce the incidence of other infections or improve bone-marrow recovery, remission rate and duration, or survival. Seventy-two per cent of the patients given transfusions had transfusion reactions. Pulmonary infiltrates were more common in the transfusion group than in the control group (57 per cent vs. 27 per cent; P = 0.002). Thirty-five per cent of the patients with pulmonary filtrates died, as compared with 5 per cent of those without filtrates. We conclude that prophylactic granulocyte transfusions should not be used during remission-induction chemotherapy in AML because the risks outweigh the benefits.

The elimination of hydroxyethyl starch (HES) from donor blood was studied following either single or multiple intermittent‐flow centrifugation leukapheresis. Immediately following pheresis, serum HES concentrations fell rapidly. The rate of elimination then slowed with trace amounts of HES persisting for weeks. Pharmaco‐kinetic analysis using a two‐compartment open model revealed an average distribution half‐life and terminal half‐life of 3.84 and 48 days, respectively. After multiple phereses, HES accumulated in serum. Although the pattern of elimination was similar, the persistence of HES was more protracted, with the serum level predicted to reach the baseline at 72 weeks pastpheresis versus 38 weeks after a single pheresis. The importance in regards to toxicity, if any, of the persistence of trace amounts of HES in donor blood is presently unknown.

Alterations of the complement system occurring during continuous‐flow filtration leukapheresis (CFFL) and intermittent‐flow centrifugation leukapheresis (IFCL) were assessed in 16 donors. Five blood samples were obtained at timed intervals during each cytaphere‐sis, three directly from each donor and two from the efferent lines returning blood from the leukapheresis machines to the donors. Components measured were C1, C2, C4, C3, C3‐C9 and CH50 of the classical, and factor B, properdin and properdin convertase of the alternative pathways. Changes in concentrations of components were compared to baseline values present in donor blood obtained prior to cytapheresis. During the first 10 minutes of CFFL, C2, C4, C3‐9 and CH50 were decreased (p < 0.05) in machine efferent fluids, but returned towards normal as the procedure continued. Changes in donor venous blood, decreased factor B, properdin and C3‐C9, were demonstrated only at the end of cytapheresis. During IFCL, significant (p < 0.05) decreases of C1, C2, C3‐C9 and factor B occurred in donor blood after 60 minutes of cytapheresis, however, all deficiencies except B corrected spontaneously as cytapheresis continued. In contrast, concentrations of C2, C4, C3‐C9, CH50 and factor B remained decreased in machine efferent fluids throughout the procedure. The data support those of previous studies that have demonstrated complement activation at the filter site during CFFL. Changes in donor venous blood are a new finding that may indicate in vivo activation of the alternative pathway. Profound changes of the complement system occur during IFCL also, but complement activation seems a less likely explanation. Instead, complement proteins may be lost by adsorption onto the surfaces of the IFCL software.