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.
Full conference title:
Annual Meeting of the EBMT, 37th
- EBMT 37th (2011)