title: Clinical experience of granulocyte transfusion in the management of neutropenic patients with haematological malignancies and severe infection.
abstract: BACKGROUND
  Prolonged chemotherapy-induced neutropenia is a major risk factor for the development of severe bacterial and fungal infections. Infectious manifestations may progress despite adequate anti-infectious treatment and lead to a very high short-term mortality. Granulocyte transfusion (GT) therapy is often considered. However, its efficacy is not well documented.
  
  
  METHODS
  We retrospectively analyzed the clinical characteristics and outcome of a cohort of patients with haematological malignancies receiving GT during neutropenia and severe infection.
  
  
  RESULTS
  A total of 30 patients with a median age of 46 y (range 3-82 y) who had received 1 or more GT were included. Acute leukaemia (80%) and non-Hodgkin lymphoma (17%) predominated as the underlying malignancy. All patients had severe and prolonged (median 16 days) neutropenia. The major indications for GT were persistent fever and clinical deterioration despite broad anti-infectious therapy, in combination with progressive pneumonia (n = 16), neutropenic enterocolitis (n = 6), and soft tissue infections (n = 3). GTs were given for a median of 3 transfusions (range 1-14). The median time to fever defervescence after GT was 14 days (range 6-33 days). For 11 patients, the resolution of fever and all signs of infection could directly be related to GT, and 3 of these patients became long-term survivors. Mortality at 30 days post-GT was 40% and at 6 months post-GT was 72%. GT was well tolerated.
  
  
  CONCLUSIONS
  A substantial proportion of severely ill neutropenic patients appeared to benefit from GT. The results further underline the need for well- designed, randomized, prospective trials to determine the efficacy of this intervention in patients with life-threatening infectious complications.
authors.affiliation: Department of Haematology, Uppsala University Hospital, Uppsala, Sweden. honar.cherif@akademiska.se
authors.forename: Honar
authors.initials: H
authors.lastname: Cherif
authors.forename: Ulla
authors.initials: U
authors.lastname: Axdorph
authors.forename: Mats
authors.initials: M
authors.lastname: Kalin
authors.forename: Magnus
authors.initials: M
authors.lastname: Björkholm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood / Q000628:therapy*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006098:Granulocytes / Q000637:transplantation*; D019337:Hematologic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007945:Leukemia, Lymphoid / Q000097:blood / Q000188:drug therapy / Q000628:therapy; D017708:Leukocyte Transfusion; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents