Efficacy and safety of G-CSF mobilized granulocyte transfusions in four neutropenic children with sepsis and invasive fungal infection.
BACKGROUND
Bacterial and fungal infections are serious complications of cancer therapy. Especially during longstanding neutropenia, patients are at risk for life-threatening infections. The aim of this study was to assess the effect and safety of G-CSF mobilized granulocyte transfusions (GTX) in four neutropenic pediatric patients with sepsis.


METHODS
The patients were between 4.6-17.5 years old and their diagnoses included very severe aplastic anemia, non-Hodgkin's lymphoma (NHL) and acute myeloid leukemia. Before GTX, all patients had fever despite antibiotic and antimycotic therapy, neutropenia (absolute neutrophil count ANC < 500/microl), increasing C-reactive protein (CRP) values, hypotension requiring dopamine infusion and three patients needed supplemental oxygen. The granulocyte donors received G-CSF (Neupogen, 5 microg/kg body weight) 12 h prior to granulocyte apheresis.


RESULTS
In total, 40 GTX were performed (range 2-28 per patient). The mean increase of the granulocyte count 1 h after GTX was 1,310/microl (range 200-2,950/microl). Within the period of GTX the CRP values decreased in all patients. During or 24 h after the last GTX, the hypotension resolved and supplemental oxygen was stopped. One GTX was discontinued because of oxygen desaturation.


CONCLUSIONS
GTX were a safe therapeutic measure with beneficial effects on serious infections in neutropenic children.
Grigull
L
L
Dept. of Pediatric Hematology and Oncology, Children's Hospital, Medical School of Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. lorenz.grigull@gmx.de
Schrauder
A
A
Schmitt-Thomssen
A
A
Sykora
K
K
Welte
K
K
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002675:Child, Preschool; D016638:Critical Illness; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D016469:Fungemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D019337:Hematologic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009503:Neutropenia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor