Granulocyte-colony-stimulating factor-mobilized prophylactic granulocyte transfusions given after allogeneic peripheral blood progenitor cell transplantation result in a modest reduction of febrile days and intravenous antibiotic usage.
BACKGROUND
It was hypothesized that transfusion of two granulocyte-colony-stimulating factor (G-CSF)-mobilized prophylactic granulocyte components into allogeneic peripheral blood progenitor cell (PBPC) transplant patients during the regimen-related neutropenic interval would result in clinical benefit.


METHODS
HLA-matched sibling PBPC donors (n=151) were biologically randomized based on ABO mismatch to donate granulocyte components (Cohort G) or not donate granulocytes (control group, Cohort C). ABO-matched donors who did not meet other study-specific criteria were reassigned to Cohort C.


RESULTS
Feasibility, defined as the proportion of ABO-matched donors who underwent granulocyte collections, was 42 percent (53 of 125). The percentage of patients who developed fever during the initial hospitalization was greater in Cohort C versus Cohort G (82.7% vs. 64.2%; p=0.03). In the interval from when granulocyte transfusions were initially given in Cohort G (Day +3 or Day +5) until neutrophil engraftment, the number of febrile days was less in Cohort G versus Cohort C (median, 0 vs. 1; Mann-Whitney p=0.003). The median number of days of intravenous antibiotics given during the initial hospitalization was less in Cohort G versus Cohort C (9 vs. 11; Mann-Whitney p=0.03), a difference accounted for in the interval from Day +3 or Day +5 to neutrophil recovery. There was no significant difference in length of the initial hospital stay, acute graft-versus-host disease rates, or 100-day survival between the two cohorts.


CONCLUSIONS
This prospective study demonstrates a modest, but significant, benefit of G-CSF-mobilized HLA-matched prophylactic granulocyte transfusions in neutropenic allogeneic PBPC recipients.
Oza
Aarti
A
Department of Internal Medicine, Division of Oncology, Barnes Jewish Hospital, Washington University School of Medicine, and Siteman Cancer Center, St. Louis, Missouri 63110-1093, USA.
Hallemeier
Chris
C
Goodnough
Lawrence
L
Khoury
Hanna
H
Shenoy
Shalini
S
Devine
Steven
S
Augustin
Kristan
K
Vij
Ravi
R
Trinkaus
Kathryn
K
Dipersio
John F
JF
Adkins
Douglas
D
D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006098:Granulocytes / Q000637:transplantation*; D006650:Histocompatibility Testing; D006801:Humans; D007275:Injections, Intravenous; D017708:Leukocyte Transfusion; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D036102:Peripheral Blood Stem Cell Transplantation; D011446:Prospective Studies; D020127:Recovery of Function; D018805:Sepsis / Q000517:prevention & control; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D000900:Anti-Bacterial Agents; D016178:Granulocyte-Macrophage Colony-Stimulating Factor