Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Supportive Care

Single-donor granulocyte transfusions for improving the outcome of high-risk pediatric patients with known bacterial and fungal infections undergoing stem cell transplantation: a 10-year single-center experience

Bone Marrow Transplantation volume 50, pages 846–849 (2015)Cite this article

Subjects

Abstract

Bacterial and fungal infections remain a significant cause of transplant-related mortality following allogeneic stem cell transplantation (SCT). Granulocyte transfusions (GTs) may reduce the neutropenic period after SCT and prevent further progression of the existing infection (that is, therapeutic GT) in addition to standard antibacterial and antifungal therapy. A retrospective analysis was performed on 28 consecutive pediatric SCT recipients who received at least one dose of GT between March 2003 and November 2013 at a single institution. All donors were conditioned with G-CSF+dexamethasone with harvest performed 12–18 h later. Indications for SCT were acute leukemia in 46% (13/28) and severe aplastic anemia in 21% (6/28). The main indications for GT were invasive fungal disease in 50%, bacterial infection in 21% and co-morbidities with predicted reduced tolerance to sepsis in 18% (5/28). The median number of GT was 6 (range 1–14) with a median dose of 3.56 × 1010 granulocytes infused. The median increment in ANC was 1.06 × 109/L and correlated with the granulocyte dose infused. Adverse reactions observed were mild and infrequent. Sixty-four percent of patients (18/28) are alive with only 2 of the 10 deaths being related to progression of infection. In addition there was a low overall incidence of grade 3–4 acute mucositis and a very low incidence (7%) of acute GvHD grade 3–4. Single-donor GTs afford protection to children undergoing SCT at additional risk of infection and may reduce the overall incidence of severe GvHD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. O’Donghaile D, Childs R, Leitman S . Blood consult: granulocyte transfusions to treat invasive aspergilosis in a patient with severe aplastic anaemia awaiting mismatched hematopoietic progenitor cell transplantation. Blood 2012; 119: 1353–1355.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Higby DJ, Yates JW, Henderson E, Holland J . Filtration leukapheresis for franulocyte transfusion therapy. Clinical and laboratory studies. N Engl J Med 1975; 292: 761–766.

    Article  CAS  PubMed  Google Scholar 

  3. Hubel K, Carter RA, Liles WC, Dale D, Price T, Bowden A et al. Granulocyte transfusion therapy for infections in candidates and recipients of HPC transplantation: a comparative analysis of feasibility and outcome for community donors versus related donors. Transfusion 2002; 42: 1414–1421.

    Article  PubMed  Google Scholar 

  4. Wheeler JG, Chauvenet AR, Johnson CA, Block SM, Dillard R, Abramson JS . Buffy coat transfusions in neonates with sepsis and neutrophil storage pool depletion. Pediatrics 1987; 79: 422–425.

    CAS  PubMed  Google Scholar 

  5. Pham HP, Rogoza K, Stotler B, Duffy D, Parker-Jones S, Ginzburg Y et al. Granulocyte transfusion therapy in pediatric patients after hematopoietic stem cell transplantation: a 5-year single tertiary care center experience. J Pediatr Hematol Oncol 2012; 34: e332–e336.

    Article  PubMed  Google Scholar 

  6. Price TH, Bowden RA, Boeckh M, Bux J, Nelson K, Liles WK et al. Phase I/II trail of neutrophil transfusion from donors stimulated with G-CSF and dexamethasone for treatment of patients with infections in hematopoietic stem cell transplantation. Blood 2000; 95: 3302–3309.

    CAS  PubMed  Google Scholar 

  7. Price TH . Granulocyte transfusion: current status. Semin Hematol 2007; 44: 15–23.

    Article  PubMed  Google Scholar 

  8. Quillen K, Wong E, Echeinberg P, Young N, Walsh T, Wu CO et al. Granulocyte transfusions in severe aplastic anemia: an eleven-year experience. Haematologica 2009; 94: 1661–1668.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gerson SL, Talbot GH, Hurwitz S, Strom B, Lusk E, Cassileth P . Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergilosis in patients with acute leukaemia. Ann Intern Med 1984; 100: 345–351.

    Article  CAS  PubMed  Google Scholar 

  10. Williamson E, Steward C, Millar MR, Cornish J, Foot AB, Oakhill A et al. Infections in adults undergoing unrelated donor bone marrow transplantation. Br J Haematol 1998; 104: 560–568.

    Article  Google Scholar 

  11. Kerr JP, Liakopolou E, Brown J, Cornish J, Fleming D, Massey E et al. The use of stimulated granulocyte transfusions to prevent recurrence of past severe infections after allogeneic stem cell transplantation. Br J Haematol 2003; 123: 114–118.

    Article  PubMed  Google Scholar 

  12. Graham AS, Price TH, Brogan TV . Revisiting the use of granulocyte transfusions in pediatric oncology patients. J Pediatr Hematol Oncol 2009; 31: 161–165.

    Article  PubMed  Google Scholar 

  13. Massey E, Paulus U, Doree C, Stanworth S . Granulocyte transfusions for preventing infections in patients with neutropenia or neutrophil dysfunction. Cochrane Database Syst Rev 2009; (1): CD005341.

    Google Scholar 

  14. Seidel MG, Petres C, Wacker A, Northoff H, Moog R, Boehme A et al. Randomized phase III study of granulocyte transfusions in neutropenic patients. Bone Marrow Transplant 2008; 42: 679–684.

    Article  CAS  PubMed  Google Scholar 

  15. Adkins DR, Goodnough LT, Shenoy S, Brown R, Moellering J, Khoury H et al. Effect of leukocyte compatibility of neutrophil increment after transfusion of granulocyte-colony-stimulating factor-mobilized prophylactic granulocyte transfusions and on clinical outcomes after stem cell transplantation. Blood 2000; 95: 3605–3612.

    CAS  PubMed  Google Scholar 

  16. Van de Watering MD, Weggelaar N, Offringa M, Caron HN, Kuijpers TW . Granulocyte transfusions in neutropenic children: a systematic review of the literature. Eur J Cancer 2007; 43: 2082–2092.

    Article  Google Scholar 

  17. Adkins DR, Spitzer G, Johnston M, Velasquez W, Dunphy F, Petruska P . Transfusion of granulocute-colony-stimulating factor-mobilized granulocyte components to allogeneic transplant recipients: analysis of kinetics and factors determining posttransfusion neutrophil and platelet count. Transfusion 1997; 37: 737–748.

    Article  CAS  PubMed  Google Scholar 

  18. Ikemoto J, Yoshihara S, Fujioka T, Ohtsuk Y, Fujita N, Kokubunji A et al. Impact of the mobilization regimen and harvesting technique on the granulocyte yield in healthy donors for granulocyte transfusion therapy. Transfusion 2012; 52: 2646–2652.

    Article  PubMed  Google Scholar 

  19. Herzig RH, Herzig GP, Graw R, Bull M, Ray K . Successful granulocyte transfusion therapy for gram-negative septicemia. A prospective randomized controlled study. N Engl J Med 1977; 296: 701–705.

    Article  CAS  PubMed  Google Scholar 

  20. Antin JH, Ferrara JL . Cytokine dysregulatuion and acute graft-versus-host disease. Blood 1992; 80: 2964.

    CAS  PubMed  Google Scholar 

  21. Cairo MS, Worcester CC, Rucker RW, Bennetts GA, Amlie R, Perkin R et al. Role of circulating complement and polymorphonuclear leukocyte transfusion in treatment and outcome in critically ill neonates with sepsis. J Pediatr 1987; 110: 935–941.

    Article  CAS  PubMed  Google Scholar 

  22. Seidel MG, Minkov M, Witt V, Matthes-Martin S, Potschger U, Worel N et al. Granulocyte transfusions in children and young adults. Does the dose matter? J Pediatr Hematol Oncol 2009; 31: 166–172.

    Article  PubMed  Google Scholar 

  23. Sachs UJ, Reiter A, Walter T, Bein G, Woessmann W . Safety and efficacy of therapeutic early onset granulocyte transfusions in pediatric patients with neutropenis and severe infections. Transfusion 2006; 46: 1909–1914.

    Article  PubMed  Google Scholar 

  24. Stanworth SJ, Massey E, Hyde C, Brunskill S, Lucas G, Navarrete C et al. Granulocyte transfusions for treating infections in patients with neutropenia or neutrophil dysfunction. Cochrane Database Syst Rev 2005; (3): CD005339.

  25. Vogler WR, Winton EF . A controlled study of the efficacy of granulocyte transfusions in patients with neutropenia. Am J Med 1977; 63: 548–555.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK

    O Nikolajeva, P Amrolia, R Chiesa, K Rao, J Silva & P Veys

  2. Department of Hematological Medicine, Kings College Hospital, London, UK

    A Mijovic, D Hess & E Tatam

Authors
  1. O Nikolajeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Mijovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D Hess
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E Tatam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P Amrolia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Chiesa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P Veys
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O Nikolajeva.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nikolajeva, O., Mijovic, A., Hess, D. et al. Single-donor granulocyte transfusions for improving the outcome of high-risk pediatric patients with known bacterial and fungal infections undergoing stem cell transplantation: a 10-year single-center experience. Bone Marrow Transplant 50, 846–849 (2015). https://doi.org/10.1038/bmt.2015.53

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2015.53

This article is cited by

Search

Advanced search

Quick links