Changing Trends in the Use of Granulocyte Transfusions in Neutropenic Children with Sepsis in India

Abstract

We present our data on granulocyte transfusions in children undergoing treatment for cancer and HSCT at our centre and their changing indications. In this retrospective observational analysis of children who received granulocytes from 2007 to 2015, we divided children receiving granulocytes into two groups-the first from January 2007 till December 2013 and the second from January 2014 till December 2015. This division is based on the change in our policy to use granulocytes within 48 h of septicemia as the incidence of drug resistant bacterial strains had increased at our centre. Data on 72 children with febrile neutropenia treated with 230 granulocyte infusions was analyzed. From 2007 to 2013 (n = 48/72), 27/48 (56 %) had culture proven sepsis of which 14 (51 %) were carbapenem resistant gram negative bacilli. 11 of the 27 children survived the crisis (41 %). We then changed our policy to transfuse granulocytes early during sepsis. From 2014 to 2015 (n = 24/72) 22 patients had culture proven sepsis (91 %) of which 20 had carbapenem resistant gram negative bacilli. 12/22 (54 %) with culture proven sepsis survived the episode. The survival rate improved from 41 % in first group to 54 % after early intervention with granulocytes ( value 0.0347). Despite the increased incidence of resistant bacteria during the period of 2014-2015, early use of granulocytes improved survival rate from 41 to 54 %. This intervention cannot be taken in isolation and needs to be offered early in parallel with appropriate antibiotics.

Role of granulocyte transfusions in combating life-threatening infections in patients with severe neutropenia: Experience from a tertiary care centre in North India

“…The mortality or comparable outcomes such as day-28 or day-30 survival, which is reflective of the mortality related to the infection has been reported to be between 6.7 and 66.7% [24–35] . There is one previous study from India in pediatric patients in which resolution of index infection was observed in 54% cases [36]. There may be several factors responsible for the wide differences reported in these studies including the dose of GTX administered, the time period in the course of infection when administered, patient populations, infection types and a low rate of patient enrolment by participating centres.…”

“…Uppuluri et al . after changing their protocol from the year 2014 onwards and administering GTX within 48 hours, showed a significant improvement in the survival from 41% to 54% (p = 0.0347) [36] . The median GTX dose/kg/IE administered by us was comparable between those who received GTX < 7 days versus those who received GTX ≥ 7 days (p = 0.851), highlighting that the benefit of early administration of GTX was not related to the GTX dose given.…”

Clinical Experience of Granulocyte Transfusion Therapy in Pediatric Patients for Management of Neutropenia-related Infections in a Tertiary Care Center in India

“…5 In another study by Uppuluri et al, the early institution of granulocytes within 48 hours of a septic episode led to a statistically significant improvement in survival from 41% to 54%. 2 Garg et al in their study also found that OS was significantly higher in patients who received granulocyte transfusion (GTX) within 7 days of neutropenic sepsis (p = 0.01). 14 In our present study, due to financial constraints and unavailability of donors, granulocyte transfusions could not be initiated early within 48 hours in most of the subjects probably leading to an inferior response rate in comparison to other studies.…”

“…Unrestricted antimicrobial use has further worsened the situation due to the development of drug resistance all over India. 2 In a surveillance study in pediatric oncology patients from a cancer center in India in Mumbai, a prevalence of communityacquired multidrug-resistant organism colonization especially due to carbapenem-resistant Enterobacteriaceae was as high as 60% and was associated with a mortality of 58-70%. 3 With the increase in incidence of drug resistance, many of these infections do not respond to treatment with appropriate antimicrobial agents.…”

Chemotherapy for Childhood Acute Myeloid Leukemia and Associated Infections Over Two Decades in India: Timeline and Impact on Outcome

“…[13,14] In our cohort, early intervention with the pediatric intensive care team in sepsis-related events, including granulocyte transfusions, has a positive impact on survival. [15] Limitations of the study include the retrospective nature, the lack of a control group and the nonavailability of MRD assessment prior to 2009.…”