Granulocyte transfusion therapy for infections in candidates and recipients of HPC transplantation: a comparative analysis of feasibility and outcome for community donors versus related donors.
BACKGROUND
Feasibility, response to granulocyte transfusion therapy, and clinical outcome were compared among HPC transplant recipients enrolled in a prospective study of a community blood bank-based unrelated donors program, a prospective granulocyte study using family donors, and matched control patients without granulocyte transfusion therapy.


METHODS
Overall, 40 patients (327 collections) received granulocyte concentrates from unrelated donors, 34 patients (219 collections) received granulocyte concentrates from related donors, and 74 patients served as controls. Study entry criteria for patients included an absolute neutrophil count (ANC) of less than 200 per microL and documented invasive fungal or bacterial infections.


RESULTS
There was a median delay of 3 days (range, 0-14) in patients receiving transfusions from unrelated donors between day of diagnosis of infection and start of granulocyte transfusion therapy as compared with a median delay of 5 days (range, 0-25) in patients receiving transfusions from related donors (p = 0.01). The ANC increment after the first, second, and seventh transfusions in patients who had community donors was significantly higher or comparable to patients who had family donors. Overall, clinical outcome was comparable between the three patient groups. Kaplan-Meier analysis revealed no difference between all cohorts in overall 6-month survival (p = 0.28, log-rank) or event-free survival (p = 0.17, log-rank).


CONCLUSIONS
These results suggest that future efficacy trials should consider inclusion of unrelated community donors for timely institution of granulocyte transfusion therapy.
Hübel
Kai
K
Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
Carter
Rachel A
RA
Liles
W Conrad
WC
Dale
David C
DC
Price
Thomas H
TH
Bowden
Raleigh A
RA
Rowley
Scott D
SD
Chauncey
Thomas R
TR
Bensinger
William I
WI
Boeckh
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001782:Blood Donors / Q000145:classification*; D002648:Child; D002675:Child, Preschool; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D015331:Cohort Studies; D018572:Disease-Free Survival; D005190:Family; D005240:Feasibility Studies; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control; D006098:Granulocytes; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D007239:Infections / Q000209:etiology / Q000628:therapy*; D007958:Leukocyte Count; D017708:Leukocyte Transfusion; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome