Therapeutic granulocyte transfusions in neutropenic patients with invasive pulmonary aspergillosis and haematological malignancies

Ref ID: 18614

Author:

K. Drognitz, M. Eckenweiler, R. Herzog, M. Lübbert, G. Illerhaus,
H. Bertz

Author address:

University of Freiburg Medical Center (Freiburg, DE)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Background: Granulocyte transfusion (GTX) is used as an additional therapeutic option in patients with severe neutropenia
following chemotherapy constituting an increased risk for lifethreatening bacterial and fungal infections. We hypothesized
that interventional GTX would provide a clinical benefi t for neutropenic patients with invasive pulmonary aspergillosis (IPA).
Methods: We reviewed the clinical outcome of 44 patients with
severe neutropenia (46 cases) and underlying haematological
malignancies suffering from IPA unresponsive to standard antifungal therapy who received a total of 181 human recombinant
granulocyte colony-stimulating factor (rh G-CSF) stimulated
GTX at Freiburg University medical center from 1996-2009.
Fourteen patients (32%) received GTX after allogeneic and 4
(9%) after autologous hematopoietic cell transplantation (HCT).
Donors were exclusively relatives and acquaintances of the
recipients. Diagnosis of IPA was achieved by computed tomography (CT) scan or serological or microbiological detection.
Response of GTX on infections was confi rmed by repeated
CT, decreasing C-reactive protein (CRP) levels, hematopoietic
regeneration and clearance of aspergillus antigen on serial
measurement.
Results: A median of 3.9 GTX (range 1-25) containing a median
total of 5.83x10e10 (range 0.3-11.28x10e10) white blood cells
per GTX were administered. All but four (2%) transfusions were
well tolerated. Mean duration of neutropenia proceeding GTX
was 20 d (2-70). Resolution of infection or clinical improvement was achieved in 29 (63%) patients with IPA and haematopoietic recovery has been assumed within fi ve days after the
last GTX in 21 patients (46%). Thirtythree (72%) patients were
alive one month after the last transfusion and median survival
was 183 days. Overall, progressive malignant disease was the
main cause of death. Patients who did not respond to GTX
died without exception on septic complications despite appropriate antibacterial and antifungal treatment. Nine out of 26
neutropenic patients receiving GTX after conventional chemotherapy underwent allo-HCT later on after control of IPA.
Conclusions: Rh G-CSF stimulated GTX is a safe and effective therapeutic tool for patients with haematological malignancies and antifungal-resistant IPA following severe neutropenia
after chemotherapy. GTX may serve as an antifungal bridging
therapy in severe neutropenic patients with IPA scheduled for
allo-HCT.

Abstract Number: P772

Conference Year: 2011

Link to conference website: NULL

New link: NULL

Conference abstracts, posters & presentations

Showing 10 posts of 17325 posts found.

  • Title

    Author

    Year

    Number

    Poster