title: Therapeutic granulocyte transfusions for the treatment of febrile neutropenia in patients with hematologic diseases: a 10-year experience at a single institute.
abstract: OBJECTIVE
  This single-center 10-year retrospective study assessed clinical efficacies and adverse events and determined prognostic factors in patients with hematologic disease and febrile neutropenia treated with granulocyte transfusions (GT) from unrelated healthy donors stimulated with recombinant human granulocyte-colony-stimulating factor (rhG-CSF) and dexamethasone.
  
  
  METHODS
  Between September 1999 and June 2009, 1027 therapeutic GT were performed for the treatment of 170 episodes of febrile neutropenia in 157 patients. Efficacy analysis included 979 GT for 138 episodes in 128 patients who received at least three GT per episode. Adverse event analysis included all patients who received at least one GT.
  
  
  RESULTS
  The median granulocyte dose was 0.96 × 10(9)/kg/transfusion (range 0.47-1.80 × 10(9)/kg/transfusion). Infection was controlled in 73 episodes (52.9%). The 28-day infection-related survival rate was 64.7 ± 4.1%. The dose of granulocytes transfused did not correlate with clinical outcome. Multivariate analysis revealed that septic shock and pneumonia/multiple primary infection sites were related to infection control failure. Furthermore, refractory underlying disease and septic shock were associated with shorter infection-related survival. Massive hemoptysis (3.5%) and respiratory failure (5.9%) occurred in a few patients. Prior pneumonic infiltration, azotemia and a larger volume of daily GT were associated with serious respiratory complications.
  
  
  CONCLUSIONS
  GT therapy is a viable adjunctive treatment option for febrile neutropenia as a bridge to autologous hematopoietic recovery in patients with hematologic disease with tolerable toxicity. GT therapy requires close monitoring in patients with prior pneumonic infiltration and azotemia. It is recommended that transfusion with higher volumes is avoided.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ki Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Hyo-Jeong
authors.initials: HJ
authors.lastname: Lim
authors.forename: Jin-Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Byung-Su
authors.initials: BS
authors.lastname: Kim
authors.forename: Soo-Mee
authors.initials: SM
authors.lastname: Bang
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
authors.forename: Kyu Sup
authors.initials: KS
authors.lastname: Han
authors.forename: Byoung-Kook
authors.initials: BK
authors.lastname: Kim
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
mesh_terms: D005260:Female; D005334:Fever / Q000628:therapy*; D006402:Hematologic Diseases / Q000628:therapy*; D006801:Humans; D017708:Leukocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009503:Neutropenia / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome