Severe infections in neutropenic immunocompromised patients are still associated with high mortality despite of appropriate antibacterial and antifungal treatment. In a prospective phase I/II study we evaluated the feasibility and efficacy of granulocyte transfusions (GT) in pediatric and adult patients with malignancies or hematological disorders. Indication were severe bacterial or fungal infections with expectable long neutropenic episodes. A total of 94 septic episodes (32 bacterial, 50 fungal, 12 unknown) in 78 patients are included in the present analysis. A total of 785 GT (371 from prednisolone-primed volunteers and 414 from rhG-CSF-stimulated family donors) were administered. All GT were irradiated with 30 Gy and infused as soon as possible after harvesting. We evaluated the response to GT in the pediatric population (age 18 years, 35 patients). The median number of GT per septic episode was 8.5 (2-40) in the pediatric and 4 (1-65) in the adult group, respectively. Pediatric patients receiving prednisolone-elicited GT achieved after the first GT a median ANC increment of 0.30 G/l (range: 0 to +3.71) versus 1.48 G/l (range: 0 to +18.61) in patients receiving rhG-CSF elicited GT. In both these pediatric subgroups of patients the increment was statistically significant. The median ANC increment after the first GT in adult patients receiving prednisolone-primed LT was 0.24 G/l (small number of observation) compared to a median 0,1 G/l (range: 0 to +1.46) in patients transfused with rhG-CSF primed GT. The probability to reach sustained ANC >0.5 G/l within 7 days of GT was 775% in the pediatric group versus 395% in the group of adult patients. Correlated to patients body weight this variable was 905% for weight 60 kg. GT were generally well tolerated in both, pediatric and adult group. No statistical significant difference was found in survival on day 28 between children and adults and in control of the underlying infection, respectively. We conclude that the cell dose of GT is important for achievement of sustained ANC increment in severely ill neutropenic patients. Thus, the choice of a stimulation modality of the donor should be met under consideration of patients body weight.
Full conference title:
American Society of Hematology 45th Annual Meeting
- ASH 45th (2003)