Granulocyte transfusions in neutropenic patients: beneficial effects proven?

Abstract

Despite the huge armamentarium of modern antibiotics and anti-fungals, infections remain life-threatening events in patients with profound neutropenia. For decades, the value of granulocyte transfusions (GT) has been explored and results are still not conclusive. However, it has been shown that GT increase peripheral blood neutrophil counts of recipients and lead to migration of functional neutrophils into inflamed tissues. A favourable increment of absolute neutrophil counts is observed after concentrates from technically up-to-date apherese from granulocyte-colony stimulating factor-stimulated donors. Most studies indicated a potential positive effect on infection elimination with a minimum cell content of GT (1.5-3 x 10(8)/kg recipient body weight). Although to date the beneficial effect of GT is not proven in prospective randomized trials, in specific situations GT is an option to treat infections along with antibiotics when there is profound neutropenia. However, these patients in critical situations need to be treated within carefully designed studies based on the best known methods for providing granulocyte concentrates in sufficient dose and frequency, standardized similar to other blood product transfusions. That includes definition of minimum cell content, maximum interval between apheresis and application, storage conditions, methods of donor stimulation according to patient's body weight and frequency of GT. This review considers the results of recent studies using GT from cytokine-stimulated donors and the consequences and effects in recipients and donors.

Granulocyte Transfusion Therapy in Pediatric Patients After Hematopoietic Stem Cell Transplantation

“…In addition, side effects in the donors from stimulation with dexamethasone and G-CSF, including posterior subcapsular cataracts and leukemia, had been suggested 18 ; thus, the donors from future trials should be followed longitudinally for these serious adverse events. Hence, regarding the dosage effect, future trials should consider the question of no stimulation, stimulation with dexamethasone only, stimulation with G-CSF only, or stimulation with both G-CSF and dexamethasone as the best method of obtaining granulocyte products.…”

Toll-like receptor–induced reactivity and strongly potentiated IL-8 production in granulocytes mobilized for transfusion purposes

“…Granulocyte transfusions (GTXs) constitute a promising adjuvant therapy in case of neutropenic and immunocompromised patients in which the exclusive use of modern antimicrobial drugs is ineffective. 1,2 To acquire a sufficient number of cells for transfusion purposes the donor is treated with a combination of G-CSF and dexamethasone (dexa) before the collection of the neutrophils by leukapheresis. 3,4 Clearly, for transfusions to be beneficial it is important that the donor granulocytes are functional.…”

Granulocyte transfusion therapy: randomization after all?

“…Several of those studies were reported in the last decade. 15 In a case-control analysis of episodes of Candida species bloodstream infections, Safdar et al detected better survival rates in high-risk patients who received granulocyte transfusions than in a control group of patients who did not. 16 Another single-center retrospective analysis included 47 patients with life-threatening infections.…”