Granulocyte Transfusions for Severe Infections after HSCT

Michael Boeckh, MD

Neutrophils (polymorphonuclear leukocytes or granulocytes) are an important component of host defense against opportunistic bacterial and fungal infections. As a result, serious infections that occur during chemotherapy-induced neutropenia are notable (and often fatal) complications of hematopoietic stem cell transplantation (HSCT). The possibility of enhancing host defenses via the infusion of neutrophils (often referred to as granulocyte transfusion therapy) from blood donors has been investigated for over 60 years, but has historically been limited by the low number of granulocytes that could be collected. With the administration of granulocyte colony stimulating factor (G-CSF) to blood donors, however, the number of active granulocytes that can be collected has been significantly increased, rekindling interest in this approach. Phase I/II studies of granulocyte transfusions for patients with severe infections during the neutropenic period after HSCT are ongoing, and will soon be superceded by a multicenter Phase III randomized controlled trial that will seek to prove that they are effective for this indication.

References:

Hübel, K., Carter, R., Liles, C., Dale, D.C., Price, T.H., Bowden, R.A., Rowley, S., Bensinger, W., Boeckh, M. Use of granulocyte donors versus related donors for granulocyte transfusion therapy of infections in hematopoietic stem cell transplant recipients: a comparative analysis of feasibility and outcome. Transfusion, 42; 1414-21, 2002.

Nichols WG, Price T, Boeckh M. Cytomegalovirus Infection in Cancer Patients Receiving Granulocyte Transfusions. Blood 2002;99:3483-4.