Impact of Preemptive Granulocyte Infusions During Febrile Neutropenia in Patients Colonized with Carbapenem-Resistant Gram-Negative Bacteria Undergoing Haploidentical Transplantation

Abstract

We prospectively studied the impact of preemptive granulocyte infusions (pGIs) in 69 patients colonized with carbapenem-resistant gram-negative bacteria (CRGNB) undergoing haploidentical hematopoietic cell transplantation (HCT) compared with a previous cohort of 33 patients who received only antimicrobials directed toward CRGNB at the onset of neutropenic fever (non-pGI group). All patients developed neutropenic fever at a median of day +8 (range, À4 to +12) after transplantation. Engraftment kinetics were similar for both groups. The median number of GIs was 2 (range, 1 to 7), and the median dose of granulocytes infused was 5 £ 10 10 granulocytes per infusion (range, 1 to 30). The overall incidence of CRGNB bloodstream infections (BSIs) was 21.2% in non-pGI group (7/33) and 17.5% (12/69) in the pGI group (P = .8). However, the CRGNB-related mortality among those with BSI was 100% (7/7) in the non-pGI group versus 16.6% (2/12) in the pGI group (P = .001). The day 100 (4.4% versus 24.4%, P = .002) and 2-year nonrelapse mortality (7.5% versus 35.6%, P = .0001) were significantly reduced in the pGI group. The overall survival at 2 years was 75.6% in the pGI group versus 21.2% in the non-pGI group (P = .0001). Colonization and subsequent BSI with CRGNB are associated with a high incidence of mortality in patients undergoing HCT. pGI reduced early mortality associated with CRGNB in colonized patients undergoing post-transplant cyclophosphamideÀbased haploidentical HCT.

Safety and efficacy of Sofosbuvir and Velpatasvir in children with active hepatitis C virus infection undergoing haploidentical transplantation

“…None were administered filgrastim. The engraftment pattern was similar to the rest of the cohort published earlier 7 . No untoward side‐effects related to Sof‐Vel was detected in any of the patients.…”

“…All patients engrafted neutrophils at a median of 15 days (range, 14‐17) and platelets at a median of 13 days (range, 12‐15 days). All had received at least one donor granulocyte infusion during the neutropenic period as per the existing protocol 7 . None were administered filgrastim.…”

Limiting the Impact of Methicillin Resistant Staphylococcus Aureus in Patients Undergoing Haploidentical Transplantation

“…As a part of prevention of CRGNB-related sepsis and mortality, pre-emptive granulocyte infusions (pGI) preferably from family members, were administered within 48 hours of the onset of fever if the absolute neutrophil count (ANC) was < 0.5 x 10 9 /l, and on alternate days until the subsidence of fever for greater than 48 hours or neutrophil engraftment as previously described. 8 ABO blood group matched donors received granulocyte colony-stimulating factor (G-CSF) and dexamethasone 8 mg orally, 18-24 hours 4 hours, respectively, before apheresis. 8 The apheresis was carried out on a continuous flow apheresis machine, Spectra Optia® (SPO, Terumo BCT, Lakewood, CO, USA).…”

“…8 ABO blood group matched donors received granulocyte colony-stimulating factor (G-CSF) and dexamethasone 8 mg orally, 18-24 hours 4 hours, respectively, before apheresis. 8 The apheresis was carried out on a continuous flow apheresis machine, Spectra Optia® (SPO, Terumo BCT, Lakewood, CO, USA). Granulocytes were collected on the established software-based protocol with an intention to collect at least 1x10 10 granulocytes per collection.…”

“…All patients in this study were colonized with CRGNB and received pGI as a part of the protocol to prevent CRGNB-related mortality. 8 All developed febrile neutropenia at a median of day + 8 (range, -4 to +13). The median number of pGI infusions was 2 (range, 1-7) (Table 2), and that was similar in both groups.…”