Granulocyte Transfusion in Febrile Neutropenia

Background: Over last 30 years cure rates are increasing among oncology patients. As the therapy intensifies, infectious complications become more common. Neutropenia is defined as neutrophil counts of <500/mm³ and it is one of the most frequent and severe complications of pediatric cancer therapy. In 12-17% of patients with febrile neutropenia, there are proven bacteremia and fungal infections. Pediatric oncology patients have a frequency of 30 morbidity and 1% mortality due to infections. Granulocyte transfusions (GTX) were found to be an effective protective and therapeutic strategy in prolonged neutropenia. GTX had been shown to be limiting the duration and complications of neutropenic period, maximum levels of CRP and duration of antibiotic usage especially after myeloablative therapy.

Materials and methods: In this study that was performed at Kanuni Sultan Süleyman Education and Research Hospital pediatric hematology-oncology unit, 170 granulocyte transfusions applied to 37 high risk febrile neutropenia attack of 23 patients were evalauted retrospectively. Granulocyte transfusions were done when the neutrophile counts were between 0 to 300 /mm³ by taking account the general status, physical examination and cultures of patients. Donors were selected according to blood types and their informed cosent were taken. The donors came to the unit one night before, 8 mg intramuscular dexamethasone and 480 mcg of G-CSF were applied. After 12 hours, granulocytes were taken from the donors by intermittent flow technique and given to patients intraveneously. The time needed for getting away from neutropenia, number of febrile days and observed adverse effects were recorded.

Results: For 23 high risk febrile neutropenic patients, granulocyte transfusion was performed at an average of 1-27 times per attack, totally 170 times in 37 attack. Eight of the patients were girls and 15 were boys, ages were ranging between 6 months to 16 years. Product quality qas found to be 1.41 x 10¹⁰; 2,14 x 10¹⁰/m². Mean days for subsiding of fever was 6.45 days, mean time for getting rid of neutropenia was 8.15 days. Three patients died during neutropenia attacks. Two of them had both infections and uncontrolled progressive primary disease. Only one patient was lost from infection even though he had antibiotic, antifungal and supportive therapy. Only upper respiratory disease symptoms were noted at 3 of the donors. In one of the patients, transfusion was stopped due to allergic reactions. No other adverse reactions were noted.

Conclusion: Our results were similar to the literature and it shows that granulocyte transfusions after myeloablative therapy limits the neutopenic period, decrease complications of neutropenia, maximum level of CRP and the duration and number of antibiotic usage. But stil controlled studies done at larger cohorts are needed.