title: Leucocyte transfusions from rhG-CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients.
abstract: Sepsis in profound neutropenia after chemotherapy is associated with high mortality despite appropriate antibacterial or antifungal treatment. In a prospective phase I/II study we evaluated the feasability and efficacy of leucocyte transfusions (LT) in patients with malignancies or haematological disorders who were suffering from severe bacterial or fungal infection during therapy-related bone marrow aplasia. 30 patients with severe neutropenia and clinical signs of life-threatening sepsis not responding to adequate treatment, received LT from rhG-CSF-stimulated family donors or from prednisolone-primed volunteers. A total of 301 LT were administered. The median number of LT per patient was seven (range three to 65), the median duration of LT treatment was 8 d (range 2-35). The white cell count (WBC), absolute neutrophil count (ANC) and lymphocyte count of the concentrates from rhG-CSF-stimulated donors were significantly higher than those from prednisolone-primed volunteers (P = 0.0001). Despite the critical condition of the patients, LT were generally well tolerated. Only 39 (12.9%) LT were associated with adverse reactions. The transfusion of leucocytes collected by continuous flow leukapheresis from both rhG-CSF and prednisolone stimulated donors resulted in a measurable increment of the peripheral leucocyte and ANC counts in our patients. On day 100 after the first LT, 20/30 patients were alive with complete clearance of the infection.
authors.affiliation: St Anna Children's Hospital, Vienna, Austria. peters@ccri.univie.ac.at
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.forename: M
authors.initials: M
authors.lastname: Minkov
authors.forename: S
authors.initials: S
authors.lastname: Matthes-Martin
authors.forename: U
authors.initials: U
authors.lastname: Pötschger
authors.forename: V
authors.initials: V
authors.lastname: Witt
authors.forename: G
authors.initials: G
authors.lastname: Mann
authors.forename: P
authors.initials: P
authors.lastname: Höcker
authors.forename: N
authors.initials: N
authors.lastname: Worel
authors.forename: J
authors.initials: J
authors.lastname: Stary
authors.forename: T
authors.initials: T
authors.lastname: Klingebiel
authors.forename: H
authors.initials: H
authors.lastname: Gadner
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007937:Leukapheresis / Q000379:methods; D017708:Leukocyte Transfusion / Q000379:methods*; D008297:Male; D009181:Mycoses / Q000209:etiology / Q000628:therapy*; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000150:complications*; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D011994:Recombinant Proteins
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D011239:Prednisolone