Granulocyte transfusions in children and young adults: does the dose matter?
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.
Seidel
Markus G
MG
St Anna Children's Hospital, Vienna, Austria.
Minkov
Milen
M
Witt
Volker
V
Matthes-Martin
Susanne
S
Pötschger
Ulrike
U
Worel
Nina
N
Leitner
Gerda
G
Stary
Jan
J
Gadner
Helmut
H
Peters
Christina
C
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