Granulocyte transfusion in paediatric haemato-oncology and haematopoietic stem cell transplantation

Abstract

Background

Severe bacterial and fungal infection remains a persistent cause of morbidity and mortality in severely neutropenic patients undergoing intensive chemotherapy and/or haematopoietic stem cell transplantation

Aim

To analyze granulocyte source, collection and storage as well as clinical efficacy and toxicity of modern granulocyte transfusions for treatment of severe bacterial and fungal infections in neutropenic patients undergoing intensive chemotherapy and/or haematopoietic stem cell transplantation.

Materials/Methods

A review of PubMed references based on evidence-based recommendations and own experience.

Results

A single dose regimen of subcutaneous G-CSF plus oral dexamethasone administered 12 hours prior to leukapheresis appears to be a cost-effective regimen for mobilizing granulocytes from normal donors. Modern continuous flow centrifugation is used to collect granulocytes, whilst a sedimenting agent such as hydroxyethyl starch removes erythrocytes. If required storage at 10°C rather than 22°C better preserves function of collected granulocytes for up to 24 hours. Peters et al. (1999) treated 30 children for documented infection, with just over half receiving G-CSF stimulated donor granulocytes. In this series 82% of bacterial and 54% of fungal infections responded. In the Netherlands 18 children have been treated with granulocyte transfusions. In children with established infection 75% responded. Transfusion reactions associated with mobilized granulocyte transfusions are similar to other blood components, and are generally mild.

Conclusions

Modern granulocyte transfusions are a relatively safe albeit controversial modality of treatment. Reasonable indications are resistant severe bacterial infection with no response to antibiotics and localized fungal infections in neutropenic patients as well as neutropenic typhilitis. The efficacy in treating or preventing sepsis remains to be established in prospective controlled trials. Within the paediatric setting, literature other than in neonates is relatively sparse and deserves further clinical studies.