Efficacy and safety of granulocyte transfusion in children: A single‐center experience

Abstract

Background Granulocyte suspension transfusion (GTx) can be used in severely neutropenic patients with infections that cannot be controlled despite appropriate antibiotic therapy. Objective We aimed to evaluate the effectiveness and safety of GTx for the treatment of febrile neutropenia (FEN) in the pediatric age group. Methods Patients who underwent GTx in the Hematology Clinic of Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital between 2013 and 2017 were evaluated retrospectively. Hematologic and clinical response rates, effects on survival, and adverse effects were investigated. Clinical response was defined at two time points: clinical response I was evaluated after each transfusion, while clinical response II was evaluated after the final GTx in a FEN episode. Results During the study period, 343 GTx were given 107 FEN episodes of 74 patients. The mean number of granulocyte suspensions administered per patient and per FEN episode was 4.6 units and 3.2 units. The mean GTx volume administered was 237 ± 40 mL, and the mean granulocyte count was 2.8 ± 1.3 x 1010/unit. Hematologic response was attained in 163 (47.6%) of 343 transfusions. Clinical response I was obtained in 88 (25.7%) of the GTx, and clinical response II was attained in 83 (78.5%) of 107 episodes. Life‐threatening adverse event was not observed. The cumulative 1‐month and 3‐month survival rates were 87.8% and 76.5%, respectively. Conclusion High hematologic response and clinical recovery rates were achieved with GTx, with no limiting adverse effects. Granulocyte transfusion appears to be a safe and effective treatment in pediatric patients with FEN.

Cui Bono? Identifying Patient Groups That May Benefit From Granulocyte Transfusions in Pediatric Hematology and Oncology

“…Several trials and case series demonstrate the general safety of granulocyte transfusions 3,6,8–10,12–17,19. This is also reflected in our data and holds true for patients receiving allogeneic stem cell transplantation, with no association between granulocyte transfusions and graft rejection or GvHD.…”

“…Similarly to a post hoc analysis of the Rituximab for Lupus Nephritis in Remission as a Goal trial20 and to a case series,14 but in contrast to other case series,10–12,15,16 we observed an association of higher cell doses with a higher likelihood of clearing the infection in neutropenia. However, these comparisons are not only biased by transfusion regimens, but in addition by different patient selection.…”

“…Other possible markers for a successful infection control with granulocyte transfusions are the type of infection, organ dysfunction, and age. 8,[10][11][12][13][14][15][16] Prospective and controlled trials are difficult to conduct. 4,5,8,9,18 Single center studies are biased by mixed patient groups with various underlying diseases in a limited number of patients.…”

“…Recent randomized trials failed to demonstrate an unequivocal benefit for granulocyte transfusions but were likely underpowered 8,9. However, as is the case for some retrospective series,7,10–17 the most recent randomized trials revealed a dose-response relation, indicating some activity of granulocyte transfusions. Many authors of case series and reviews conclude that granulocyte transfusions show a benefit for some patient groups.…”

“…One of the most plausible parameters that predict the success of granulocyte transfusions is the granulocyte dose that is applied per time. Other possible markers for a successful infection control with granulocyte transfusions are the type of infection, organ dysfunction, and age 8,10–16…”