title: Combined treatment with amphotericin-B and granulocyte transfusion from G-CSF-stimulated donors in an aplastic patient with invasive aspergillosis undergoing bone marrow transplantation.
abstract: Granulocyte transfusions from G-CSF stimulated donors were added to standard anti-infective treatment in preparation for and during allogeneic bone marrow transplantation in a young man affected by very severe acute aplastic anemia and invasive aspergillosis. Nine concentrates with a mean neutrophil content of 18.7 x 10(9)/L (2.6 x 10(8)/kg patient b.w.) were transfused before and after marrow infusion. An impressive clinical improvement was noticed after each granulocyte transfusion, although this was not always paralleled by a neutrophil increase in the peripheral blood. Engraftment (N > 0.5 x 10(9)/L and Plt > 25 x 10(9)/L) was verified at +16 and +40 days, respectively. The patient is currently in complete hematological and microbiological remission 14 months after transplantation. Granulocyte apheresis from G-CSF stimulated donors provides a high number of activated neutrophils. At the dose given (300 micrograms/day) donor tolerance to G-CSF was excellent. This new approach is indicated when life-threatening infections develop in patients exposed to prolonged severe neutropenia.
authors.affiliation: Division of Hematology, Federico II University Medical School, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Catalano
authors.forename: R
authors.initials: R
authors.lastname: Fontana
authors.forename: N
authors.initials: N
authors.lastname: Scarpato
authors.forename: M
authors.initials: M
authors.lastname: Picardi
authors.forename: S
authors.initials: S
authors.lastname: Rocco
authors.forename: B
authors.initials: B
authors.lastname: Rotoli
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000741:Anemia, Aplastic / Q000150:complications / Q000628:therapy*; D000935:Antifungal Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D001232:Aspergillus fumigatus; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006098:Granulocytes / Q000637:transplantation*; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D017708:Leukocyte Transfusion; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D012074:Remission Induction
chemical_list: D000935:Antifungal Agents; D000998:Antiviral Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D017964:Itraconazole; D000666:Amphotericin B; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; C082430:molgramostim; D000069585:Filgrastim; D000212:Acyclovir