Phase I/II trial of neutrophil transfusions from donors stimulated with G-CSF and dexamethasone for treatment of patients with infections in hematopoietic stem cell transplantation.
We examined the feasibility of a community blood bank granulocyte transfusion program utilizing community donors stimulated with a single-dose regimen of subcutaneous granulocyte colony-stimulating factor (G-CSF) plus oral dexamethasone. The recipients of these transfusions were neutropenic stem cell transplantation patients with severe bacterial or fungal infection. Nineteen patients received 165 transfusions (mean 8.6 transfusions/patient, range 1-25). Community donors provided 94% of the transfusions; relatives accounted for only 6% of the transfusions. Sixty percent of the community donors initially contacted agreed to participate, and 98% of these individuals indicated willingness to participate again. Transfusion of 81.9 +/- 2.3 x 10(9) neutrophils (mean +/- SD) resulted in a mean 1-hour posttransfusion neutrophil increment of 2. 6 +/- 2.6 x 10(3)/microL and restored the peripheral neutrophil count to the normal range in 17 of the 19 patients. The buccal neutrophil response, a measure of the capacity of neutrophils to migrate to tissue sites in vivo, was restored to normal in most patients following the transfusion. Chills, fever, and arterial oxygen desaturation of >/= 3% occurred in 7% of the transfusions, but these changes were not sufficient to limit therapy. Infection resolved in 8 of 11 patients with invasive bacterial infections or candidemia. These studies indicate that transfusion of neutrophils from donors stimulated with G-CSF plus dexamethasone can restore a severely neutropenic patient's blood neutrophil supply and neutrophil inflammation response. Further studies are needed to evaluate the clinical efficacy of this therapy.
Price
T H
TH
Department of Medicine, University of Washington, Puget Sound Blood Center, Seattle, WA 98105-1256, USA.
Bowden
R A
RA
Boeckh
M
M
Bux
J
J
Nelson
K
K
Liles
W C
WC
Dale
D C
DC
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy; D001424:Bacterial Infections / Q000628:therapy*; D001782:Blood Donors; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007279:Injections, Subcutaneous; D007938:Leukemia / Q000628:therapy; D007958:Leukocyte Count / Q000187:drug effects; D017708:Leukocyte Transfusion / Q000009:adverse effects; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000628:therapy*; D009190:Myelodysplastic Syndromes / Q000628:therapy; D009504:Neutrophils / Q000187:drug effects / Q000502:physiology
D016179:Granulocyte Colony-Stimulating Factor; D003907:Dexamethasone