Leucocyte transfusions from rhG-CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients.
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.
Peters
C
C
St Anna Children's Hospital, Vienna, Austria. peters@ccri.univie.ac.at
Minkov
M
M
Matthes-Martin
S
S
Pötschger
U
U
Witt
V
V
Mann
G
G
Höcker
P
P
Worel
N
N
Stary
J
J
Klingebiel
T
T
Gadner
H
H
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
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D011239:Prednisolone