title: Role of granulocyte transfusions in invasive fusariosis: systematic review and single-center experience.
abstract: BACKGROUND
  Invasive Fusarium infection is relatively refractory to available antifungal agents. Invasive fusariosis (IF) occurs almost exclusively in the setting of profound neutropenia and/or systemic corticosteroid use. Treatment guidelines for IF are not well established, including the role of granulocyte transfusions (GTs) to counter neutropenia.
  
  
  METHODS
  We conducted a systematic review, identifying IF cases where GTs were used as adjunctive therapy to antifungal agents and also report a single-center case series detailing our experience (1996-2012) of all IF cases treated with antifungal agents and GTs. In the systematic review cases, GTs were predominantly collected from nonstimulated donors whereas, in the case series, they were universally derived from dexamethasone- and granulocyte-colony-stimulating factor-stimulated donors.
  
  
  RESULTS
  Twenty-three patients met inclusion criteria for the systematic review and 11 for the case series. Response rates after GTs were 30 and 91% in the review and case series, respectively. Survival to hospital discharge remained low at 30 and 45%, respectively. Ten patients in the systematic review and three in the case series failed to achieve hematopoietic recovery and none of these survived. In the case series, donor-stimulated GTs generated mean "same-day" neutrophil increments of 3.35 × 10(9)  ± 1.24 × 10(9) /L and mean overall posttransfusion neutrophil increments of 2.46 × 10(9)  ± 0.85 × 10(9) /L. Progressive decrements in neutrophil response to GTs in two cases were attributed to GT-related HLA alloimmunization.
  
  
  CONCLUSIONS
  In patients with IF, donor-stimulated GTs may contribute to high response rates by effectively bridging periods of neutropenia or marrow suppression. However, their utility in the absence of neutrophil recovery remains questionable.
authors: Department of Critical Care Medicine, NIH Clinical Center, National Institutes of Health.
authors: Sameer S
authors: SS
authors: Kadri
authors: Department of Critical Care Medicine, NIH Clinical Center, National Institutes of Health.
authors: Kenneth E
authors: KE
authors: Remy
authors: Department of Internal Medicine, MedStar-Georgetown University Hospital, Washington, DC.
authors: Jeffrey R
authors: JR
authors: Strich
authors: National Cancer Institute, Experimental Transplantation and Immunology Branch, National Institutes of Health.
authors: Juan
authors: J
authors: Gea-Banacloche
authors: Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland.
authors: Susan F
authors: SF
authors: Leitman
mesh_terms: D005260:Female; D060585:Fusariosis / Q000453:epidemiology / Q000628:therapy*; D006098:Granulocytes / Q000637:transplantation*; D006801:Humans; D017708:Leukocyte Transfusion / Q000379:methods*; D008297:Male