Reemphasis on Leukocyte Transfusions: Induction of Myeloid Marrow Recovery in Critically ill Neutropenic Children with Cancer

Abstract

Neutropenia is the major factor predisposing to sepsis in cancer patients, and its duration is important for survival. We administered leukocyte transfusions (LT) to 10 children suffering from documented life-threatening infections during profound, prolonged neutropenia. Nine had acute leukemia, and one had aplastic anemia; three were bone marrow transplant recipients. These 10 were the only patients in our unit who received LT during the past 7 years. The median leukocyte dose was 0.6x10^9/kg in total. Instead of leukapheresis products, we used pooled buffy coats from random donors, with a high relative content of lymphocytes and especially T lymphocytes. The leukocyte concentrates were irradiated with 15 Gy. In all 10 patients, we observed prompt and sustained myeloid marrow recovery following LT. Such an effect of LT has never been described before. We hypothesize that in the internal milieu of these aplastic patients the transfused leukocytes were stimulated to secrete cytokines, the result being a cascade-like phenomenon and stimulation and proliferation of the patient’s own bone marrow cells. The bone marrow-stimulating effect of LT merits further study.

Leukocyte transfusions revisited: Stem cell graft stimulation in graft failure

“…In another 23% their sustained engraftment post-LTX could not be unequivocally linked to LTX. This is in accordance with our earlier data [9]. The temporal correlation with LTX and the subsequent myeloid engraftment was convincing: the ANC levels of 0.2 Â 10 9 /L and 0.5 Â 10 9 /L were reached in median at 3 and 6 days post-LTX in patients who had been profoundly neutropenic for a median of 20 days in spite of ongoing G-CSF therapy.…”

“…We earlier reported about LTX inducing myeloid marrow recovery in severely ill neutropenic children with cancer by using irradiated, pooled buffy coats from random blood donors [9]. All ten patients experienced a prompt and sustained myeloid marrow recovery after 3 days of LTX.…”

Leucocyte transfusions from rhG‐CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients

“…Although they all received interventional haemopoietic growth factors there were no signs of myeloid proliferation before LT either in peripheral blood or in bone marrow. One possible explanation might be a cascade-like phenomenon for cytokine secretion resulting in a proliferation of the patient's stem cells following LT (Saarinen et al, 1995).…”