title: Single-donor granulocyte transfusions for improving the outcome of high-risk pediatric patients with known bacterial and fungal infections undergoing stem cell transplantation: a 10-year single-center experience.
abstract: Bacterial and fungal infections remain a significant cause of transplant-related mortality following allogeneic stem cell transplantation (SCT). Granulocyte transfusions (GTs) may reduce the neutropenic period after SCT and prevent further progression of the existing infection (that is, therapeutic GT) in addition to standard antibacterial and antifungal therapy. A retrospective analysis was performed on 28 consecutive pediatric SCT recipients who received at least one dose of GT between March 2003 and November 2013 at a single institution. All donors were conditioned with G-CSF+dexamethasone with harvest performed 12-18 h later. Indications for SCT were acute leukemia in 46% (13/28) and severe aplastic anemia in 21% (6/28). The main indications for GT were invasive fungal disease in 50%, bacterial infection in 21% and co-morbidities with predicted reduced tolerance to sepsis in 18% (5/28). The median number of GT was 6 (range 1-14) with a median dose of 3.56 × 10(10) granulocytes infused. The median increment in ANC was 1.06 × 10(9)/L and correlated with the granulocyte dose infused. Adverse reactions observed were mild and infrequent. Sixty-four percent of patients (18/28) are alive with only 2 of the 10 deaths being related to progression of infection. In addition there was a low overall incidence of grade 3-4 acute mucositis and a very low incidence (7%) of acute GvHD grade 3-4. Single-donor GTs afford protection to children undergoing SCT at additional risk of infection and may reduce the overall incidence of severe GvHD.
authors.affiliation: Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Nikolajeva
authors.affiliation: Department of Hematological Medicine, Kings College Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mijovic
authors.affiliation: Department of Hematological Medicine, Kings College Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Hess
authors.affiliation: Department of Hematological Medicine, Kings College Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Tatam
authors.affiliation: Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Amrolia
authors.affiliation: Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Chiesa
authors.affiliation: Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Rao
authors.affiliation: Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Silva
authors.affiliation: Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Veys
mesh_terms: D064591:Allografts; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy; D001424:Bacterial Infections / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001782:Blood Donors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006098:Granulocytes / Q000637:transplantation; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy; D017708:Leukocyte Transfusion; D008297:Male; D009181:Mycoses / Q000209:etiology / Q000401:mortality / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation
references.citation: Br J Haematol. 2003 Oct;123(1):114-8
references.pmid: 14510952
references.citation: Transfusion. 2006 Nov;46(11):1909-14
references.pmid: 17076845
references.citation: Haematologica. 2009 Dec;94(12):1661-8
references.pmid: 19996117
references.citation: Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005339
references.pmid: 16034970
references.citation: Eur J Cancer. 2007 Sep;43(14):2082-92
references.pmid: 17761413
references.citation: Ann Intern Med. 1984 Mar;100(3):345-51
references.pmid: 6696356
references.citation: Am J Med. 1977 Oct;63(4):548-55
references.pmid: 910806
references.citation: N Engl J Med. 1975 Apr 10;292(15):761-6
references.pmid: 1089885
references.citation: Blood. 2000 Jun 1;95(11):3605-12
references.pmid: 10828051
references.citation: J Pediatr Hematol Oncol. 2009 Mar;31(3):166-72
references.pmid: 19262241
references.citation: Blood. 2000 Jun 1;95(11):3302-9
references.pmid: 10828009
references.citation: Blood. 1992 Dec 15;80(12):2964-8
references.pmid: 1467511
references.citation: N Engl J Med. 1977 Mar 31;296(13):701-5
references.pmid: 320476
references.citation: J Pediatr. 1987 Jun;110(6):935-41
references.pmid: 3585610
references.citation: Bone Marrow Transplant. 2008 Nov;42(10):679-84
references.pmid: 18695660
references.citation: Transfusion. 2012 Dec;52(12):2646-52
references.pmid: 22519863
references.citation: Semin Hematol. 2007 Jan;44(1):15-23
references.pmid: 17198843
references.citation: Blood. 2012 Feb 9;119(6):1353-5
references.pmid: 22110248
references.citation: Transfusion. 1997 Jul;37(7):737-48
references.pmid: 9225939
references.citation: J Pediatr Hematol Oncol. 2009 Mar;31(3):161-5
references.pmid: 19262240
references.citation: Transfusion. 2002 Nov;42(11):1414-21
references.pmid: 12421213
references.citation: J Pediatr Hematol Oncol. 2012 Nov;34(8):e332-6
references.pmid: 22858567
references.citation: Pediatrics. 1987 Mar;79(3):422-5
references.pmid: 3547298
references.citation: Br J Haematol. 1999 Mar;104(3):560-8
references.pmid: 10086795
references.citation: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005341
references.pmid: 19160254