title: Granulocyte transfusions in children and young adults: does the dose matter?
abstract: BACKGROUND
  Granulocyte transfusions (GTs) may increase the absolute neutrophil count (ANC) before hematopoietic regeneration in neutropenic patients after chemotherapy or hematopoietic stem cell transplantation and support anti-infective immunity.
  
  
  METHODS
  We assessed efficacy and tolerability of 778 GTs in 70 treatment episodes of 49 children and 10 young adults [median age 6.28 y (range: 0.13 to 17.7 y) and 21 y (18.0 to 28.0), respectively] suffering from bacterial (n=55) and/or fungal (n=31) infections during neutropenia owing to conventional chemotherapy (n=14), hematopoietic stem cell transplantation conditioning (n=44), or the underlying disease (n=1). We analyzed the impact of body weight, organ dysfunction, neutrophil dose on ANC increment, infection elimination, and survival.
  
  
  RESULTS
  The median day-5 ANC increment was 1460/microL, correlating to the administered dose. However, 28-day survival did not correlate to the neutrophil dose nor to the ANC increment, potentially owing to the high number of neutrophils transfused to all patients (median >6x10(9)/kg within 5 d). The 28-day survival probability of the total patient cohort was 0.72+/-0.06 and the 100-day survival was 0.52+/-0.07. Adverse reactions were rare including fever (< or =World Health Organization grade III, 14%), chills (3%), and mild pulmonary complications (1%).
  
  
  CONCLUSIONS
  These data corroborate the empirical evidence that GT with sufficient cell doses and rapid availability are a feasible, well-tolerated supplemental means to fight severe infections in neutropenic patients.
authors.affiliation: St Anna Children's Hospital, Vienna, Austria.
authors.forename: Markus G
authors.initials: MG
authors.lastname: Seidel
authors.forename: Milen
authors.initials: M
authors.lastname: Minkov
authors.forename: Volker
authors.initials: V
authors.lastname: Witt
authors.forename: Susanne
authors.initials: S
authors.lastname: Matthes-Martin
authors.forename: Ulrike
authors.initials: U
authors.lastname: Pötschger
authors.forename: Nina
authors.initials: N
authors.lastname: Worel
authors.forename: Gerda
authors.initials: G
authors.lastname: Leitner
authors.forename: Jan
authors.initials: J
authors.lastname: Stary
authors.forename: Helmut
authors.initials: H
authors.lastname: Gadner
authors.forename: Christina
authors.initials: C
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006098:Granulocytes / Q000637:transplantation; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D017708:Leukocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009503:Neutropenia / Q000401:mortality / Q000628:therapy*; D014777:Virus Diseases / Q000401:mortality / Q000628:therapy*; D055815:Young Adult