Granulocyte transfusion therapy.
Bacterial and fungal infections continue to be a major cause of morbidity and mortality in severely neutropenic patients undergoing aggressive chemotherapy regimens or hematopoietic stem cell transplantation. Traditional granulocyte transfusion therapy, a logical approach in treating these infections, has been available for many years, and several controlled studies have shown this therapy to be useful. However, granulocyte transfusion therapy fell out of favor because the results were not clinically impressive, and adverse results were reported. These disappointing results were felt to be, in part, because of the low doses of granulocytes provided. More recent studies have attempted to increase the numbers of transfused cells by stimulating normal granulocyte donors with G-CSF (+/-corticosteroids). With these techniques, the number of granulocytes transfused can be increased 3-4 fold. The cells have been shown to circulate in recipients, and daily transfusions are capable of maintaining normal or near-normal blood neutrophil counts in previously severely neutropenic patients. The cells appear to function normally by a variety of in vitro and in vivo tests. Clinical benefit, as defined by survival or clearance of infection, has not been definitively determined. Results of an ongoing randomized controlled clinical trial should be available in the near future.
Puget Sound Blood Center, Seattle, WA, USA Current Address: HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Anthony A
AA
Marfin
Puget Sound Blood Center, Seattle, WA, USA Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA thprice2@comcast.net.
Thomas H
TH
Price
D001424:Bacterial Infections / Q000276:immunology / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D004306:Dose-Response Relationship, Immunologic; D016179:Granulocyte Colony-Stimulating Factor / Q000276:immunology*; D006098:Granulocytes / Q000637:transplantation*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D009181:Mycoses / Q000276:immunology / Q000628:therapy*; D009503:Neutropenia / Q000276:immunology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D014019:Tissue Donors; D016896:Treatment Outcome
D016179:Granulocyte Colony-Stimulating Factor
G-CSF; apheresis; bacterial infection; chemotherapy; fungal infection; granulocyte transfusion; granulocytopenia; neutropenia; neutrophil transfusion; stem cell transplantation