TY - JOUR
T1 - Use of healthy-donor granulocyte transfusions to treat infections in neutropenic patients with myeloid or lymphoid neoplasms
T2 - Experience in 74 patients treated with 373 granulocyte transfusions
AU - Safdar, Amar
AU - Rodriguez, Gilhen
AU - Zuniga, Jorge
AU - Al Akhrass, Fadi
AU - Pande, Anupam
PY - 2013/12
Y1 - 2013/12
N2 - Background/Aims: Despite limited evidence for efficacy, granulocyte transfusions (GTX) are used to prevent and treat opportunistic infections in patients with neutropenia. Methods: Three hundred and seventy-three GTX given to 74 patients were assessed retrospectively. Results: GTX were discontinued because of clinical improvement more often in patients with severe infections than in patients without severe infections (27 vs. 12%; p ≤ 0.002), whereas deaths resulted in discontinuation of GTX therapy less often in patients with severe infections than without (8 vs. 39%; p ≤ 0.002). Patients who died by 12 weeks after GTX initiation were more likely to have leukemia (p = 0.03), not to have recovery of neutrophil counts (p < 0.0001), and to have started GTX during a critical care unit stay (p < 0.001). Uses of granulocyte colony-stimulating factor (p ≤ 0.02) and interferon-γ (p ≤ 0.04) were more common in patients who survived. In patients with comorbidities (31%; odds ratio, OR, 12.6; 95% confidence interval, CI, 2.4-65.7; p ≤ 0.003), GTX was started in the critical care unit (OR 8.8; 95% CI 2.5-30.9; p < 0.001), and a high total bilirubin level at the end of GTX (OR 2.1; 95% CI 1.1-4.2; p = 0.03) had a higher probability of death 12 weeks after GTX therapy commenced. Conclusions: The possibility that a niche population may benefit from GTX requires further assessment.
AB - Background/Aims: Despite limited evidence for efficacy, granulocyte transfusions (GTX) are used to prevent and treat opportunistic infections in patients with neutropenia. Methods: Three hundred and seventy-three GTX given to 74 patients were assessed retrospectively. Results: GTX were discontinued because of clinical improvement more often in patients with severe infections than in patients without severe infections (27 vs. 12%; p ≤ 0.002), whereas deaths resulted in discontinuation of GTX therapy less often in patients with severe infections than without (8 vs. 39%; p ≤ 0.002). Patients who died by 12 weeks after GTX initiation were more likely to have leukemia (p = 0.03), not to have recovery of neutrophil counts (p < 0.0001), and to have started GTX during a critical care unit stay (p < 0.001). Uses of granulocyte colony-stimulating factor (p ≤ 0.02) and interferon-γ (p ≤ 0.04) were more common in patients who survived. In patients with comorbidities (31%; odds ratio, OR, 12.6; 95% confidence interval, CI, 2.4-65.7; p ≤ 0.003), GTX was started in the critical care unit (OR 8.8; 95% CI 2.5-30.9; p < 0.001), and a high total bilirubin level at the end of GTX (OR 2.1; 95% CI 1.1-4.2; p = 0.03) had a higher probability of death 12 weeks after GTX therapy commenced. Conclusions: The possibility that a niche population may benefit from GTX requires further assessment.
KW - Granulocyte transfusions
KW - Immunosuppression
KW - Infection-attributed deaths
KW - Leukemia
KW - Life-threatening infections
KW - Toxicity
UR - http://www.scopus.com/inward/record.url?scp=84890959208&partnerID=8YFLogxK
U2 - 10.1159/000351174
DO - 10.1159/000351174
M3 - Article
C2 - 24051981
AN - SCOPUS:84890959208
VL - 131
SP - 50
EP - 58
JO - Acta Haematologica
JF - Acta Haematologica
SN - 0001-5792
IS - 1
ER -