title: Treatment of neutropenia-related fungal infections with granulocyte colony-stimulating factor-elicited white blood cell transfusions: a pilot study.
abstract: Neutropenia-related fungal infections can be life-threatening despite antifungal therapy. We evaluated the role of recombinant granulocyte colony-stimulating factor (rG-CSF)-elicited white blood cell (WBC) transfusions in patients with neutropenia-related fungal infections. Adult patients with hematologic malignancies, absolute neutrophil counts (ANC) <500/microl and fungal infections refractory to amphotericin B, received daily transfusions of rG-CSF-elicited and irradiated WBC transfusions from related donors. Donors received 5 microg/kg/day of rG-CSF subcutaneously. Donors achieved a mean ANC of 29.4 x 10(3) per microliter. The mean yield of neutrophils per transfusion was 41 x 10(9) (range, 10-116). Fifteen patients received a median of eight transfusions (range, 3-16). Fourteen patients had received rG-CSF for a median of 12 days. The median ANC baseline was 20/microl. Eleven patients had favorable responses and eight of them remained free of infection 3 weeks after therapy. Favorable responses occurred among patients with better Zubrod performance status (median, 3 vs 4) and shorter duration of both profound neutropenia (median, 15 vs 25 days) and active infection (median, 8 vs 17 days). The mean 1- and 24-h post-transfusion ANCs were 594/microl (range, 98-1472/microl) and 396/microl (range, 50-1475/microl), respectively. Adverse reactions were observed in nine of 35 donors and in the recipients of six of 130 transfusions. rG-CSF-elicited WBC transfusions may be a safe and promising approach for treating neutropenia-related fungal infections.
authors.affiliation: Infectious Diseases, Fundaleu, Buenos Aires, Argentina.
authors.forename: M C
authors.initials: MC
authors.lastname: Dignani
authors.forename: E J
authors.initials: EJ
authors.lastname: Anaissie
authors.forename: J P
authors.initials: JP
authors.lastname: Hester
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: S E
authors.initials: SE
authors.lastname: Vartivarian
authors.forename: J H
authors.initials: JH
authors.lastname: Rex
authors.forename: H
authors.initials: H
authors.lastname: Kantarjian
authors.forename: D B
authors.initials: DB
authors.lastname: Jendiroba
authors.forename: B
authors.initials: B
authors.lastname: Lichtiger
authors.forename: B S
authors.initials: BS
authors.lastname: Andersson
authors.forename: E J
authors.initials: EJ
authors.lastname: Freireich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001782:Blood Donors; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D017708:Leukocyte Transfusion; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000628:therapy*; D009503:Neutropenia / Q000382:microbiology* / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D000935:Antifungal Agents; D016179:Granulocyte Colony-Stimulating Factor; D000666:Amphotericin B