Granulocyte transfusions: A concise review for practitioners

Abstract

Granulocyte transfusions (GTXs) have been used to treat and prevent infections in neutropenic patients for more than 40 years, despite persistent controversy regarding their efficacy. This narrative review attempts to complement recent systematic reviews by the Cochrane Collaboration and provide both historical context and critical assessment of the most significant clinical studies published over the years. The data suggest that properly collected and promptly infused granulocytes are active against infections, both bacterial and fungal. The most important question that remains unanswered is in which patients the administration of granulocytes will be beneficial. The preponderance of evidence suggests that granulocyte transfusions may be efficacious in few select cases as a temporizing measure to control an infection that is expected (or proven) to be refractory to optimal antimicrobial treatment, and that could otherwise be controlled by marrow recovery, which is expected to happen. In this regard, they are best considered a “bridge” that grants enough time for the recipient to develop their own response to the infection. The challenges to use GTXs successfully are both clinical, in terms of timely identifying the patients who may benefit, and logistical, in terms of optimal selection of donors and collection technique.

Disseminated Geotrichosis in Prolonged Neutropenia

“…In this case, susceptibility test results suggested G. capitatum was sensitive to amphotericin-B, fluconazole, voriconazole and flucytosine and resistant to caspofungin. Some authors have mentioned the use of granulocytecolony stimulating factors, granulocyte transfusions and interferon-gamma in addition to antifungal treatment with varying success [11].…”

How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients

“…First, removal of CVCs should be considered when there is evidence of refractory shock caused by MDR pathogens (43,44). Second, salvage therapies aimed at restoring immunity should be considered and include reduction in or even withdrawal of immunosuppression, use of colony stimulating factors (G-CSF and GM-CSF) (45), and granulocyte transfusions (46). Augmenting immune recovery is key to best outcomes, but both cytokines and granulocyte transfusions have potential adverse effects like worsening inflammation, bone pain, and hypoxemia.…”

Granulozytentransfusion: Update 2020

“…Es gilt, die Frage zu beantworten, unter welchen Umständen und bei welcher Patientenpopulation ein Benefit erzielt werden kann. Viele Autoren postulieren seit Längerem die Notwendigkeit der Transfusion möglichst hoher Zellzahlen [15,45,46,48,49]. Neuere Studien sprechen sich jedoch teilweise eher für eine mittlere als zu hohe Dosis aus.…”

“…Unter bestimmten Umständen, die es noch genauer zu definieren gilt, kann also mit einer Granulozytenspende ein Effekt erzielt werden. Man sollte allerdings stets im Hinterkopf behalten, dass dies generell nur eine überbrückende Maßnahme sein kann und das Überleben maßgeblich von einer wiedereinsetzenden Funktion des Knochenmarks abhängt [48,54,55].…”