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Özkan SG, Kimiaei A, Safaei S, Sönmezoğlu M, Özkan HA. Granulocyte Transfusions in Neutropenic Infections: Insights From a Single-Center Study. Cureus 2024; 16:e55953. [PMID: 38601410 PMCID: PMC11005880 DOI: 10.7759/cureus.55953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Despite the development of modern antibiotic and antifungal therapies, neutropenic infections remain life-threatening. Granulocyte transfusion (GTX) is a less frequently used treatment modality in patients with refractory neutropenic infections. The role of donor GTX remains controversial, partly because of the lack of proper clinical trials. This study aimed to contribute to the literature by evaluating the efficacy and side effects of granulocyte transfusions in our center. Methods Eight febrile neutropenic patients with confirmed infections received granulocyte transfusions from ABO-compatible related and unrelated donors. Donors received filgrastim and dexamethasone stimulation, and granulocyte suspensions were irradiated and administered within six hours. Monitoring, antibiotic therapy, and granulocyte colony-stimulating factor (G-CSF) support were maintained. Results Our study observed a 28-day survival rate of 25%, which was lower than that reported in previous literature. The median number of transfusions was 3, with an average eight-day duration post-infection diagnosis, and no side effects were observed. Conclusion While some patients benefited from GTX, overall survival rates remained modest, indicating the need for further research. Prospective, well-powered randomized controlled trials are essential to address patient selection, dosing, and duration to determine the clinical utility of GTX. This study underscores the complexity of GTX in real-world clinical practice and provides insight into the ongoing debate regarding its efficacy in treating severe neutropenic infections.
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Affiliation(s)
| | - Ali Kimiaei
- Hematology, Bahçeşehir University, Istanbul, TUR
| | | | - Meral Sönmezoğlu
- Infectious Diseases, Yeditepe University Hospital, Istanbul, TUR
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Henzan T, Yamauchi T, Yamanaka I, Sakoda T, Semba Y, Hayashi M, Kikushige Y, Mishima H, Ishimura M, Koga Y, Miyamoto T, Ohga S, Akashi K, Maeda T, Kunisaki Y. Granulocyte collection by polymorphonuclear cell-targeting apheresis with medium-molecular-weight hydroxyethyl starch. Int J Hematol 2021; 114:691-700. [PMID: 34453685 DOI: 10.1007/s12185-021-03207-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
Granulocyte transfusion (GTX) is a therapeutic option for patients with prolonged neutropenia suffering from severe infections. Efficient granulocyte collection by apheresis from donors requires clear separation of granulocytes from red blood cells (RBCs), and infusion of high-molecular-weight (MW) hydroxyethyl starch (HES) facilitates RBC sedimentation. Recent research has shown that apheresis with medium-MW HES may prevent adverse effects of high-MW HES on donors, but the rationale for collection with medium-MW HES has yet to be evaluated. To validate the use of medium-MW HES, we first performed experiments with whole blood samples to determine how efficiently high-, medium- and low-MW HES separated granulocytes from RBCs, and found that medium-MW HES was just as efficient as high-MW HES. We also reviewed clinical data of granulocyte apheresis at our institution to evaluate granulocyte yields. Retrospective analysis of granulocyte collection revealed that apheresis with medium-MW HES yielded sufficient granulocytes for GTX and that donor anemia reduced collection efficiency. These results collectively may help us to establish a safer method for apheresis targeting polymorphonuclear granulocytes as an alternative to high-MW HES.
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Affiliation(s)
- Tomoko Henzan
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takuji Yamauchi
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ikumi Yamanaka
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Teppei Sakoda
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuichiro Semba
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masayasu Hayashi
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshikane Kikushige
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Mishima
- Department of Medical Technology, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582, Japan
| | - Takahiro Maeda
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Division of Precision Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582, Japan
| | - Yuya Kunisaki
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Morton S, Stanworth S, Lozano M, Harrison S, Hong F, Dennington P, McQuilten Z, Worel N, Compernolle V, Kutner J, Yokoyama A, Nahirniak S, Germain M, Hume H, Robitaille N, Wilson A, Tinmouth A, Massey E, Boulat C, Woimant G, Tiberghien P, Schulze TJ, Bux J, Pierelli L, Ballester C, Netelenbos T, West KA, Conry-Cantilena C, Eder A, Haley NR, Yazer M, Triulzi D. Vox Sanguinis International Forum on provision of granulocytes for transfusion and their clinical use. Vox Sang 2017; 112:e48-e68. [DOI: 10.1111/vox.12523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Morton
- NHS Blood and Transplant; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - S. Stanworth
- NHS Blood and Transplant; Oxford University Hospital NHS Foundation Trust; Oxford UK
| | | | - S.J. Harrison
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Victoria Comprehensive Cancer Centre, Grattan Street; Melbourne Vic. 3000 Australia
- Sir Peter MacCallum Department of Oncology; Melbourne University; Melbourne Vic. 3000 Australia
| | - F.S. Hong
- Clinical Services and Research; Australian Red Cross Blood Service; 100 Batman St West Melbourne Vic. 3003 Australia
| | - P. Dennington
- Clinical Services and Research; Australian Red Cross Blood Service; 17 O'Riordan Street Alexandria NSW 2015 Australia
| | - Z. McQuilten
- Department of Epidemiology and Preventive Medicine; Monash University; Level 6, 99 Commercial Road Melbourne Vic. 3001 Australia
| | - N. Worel
- Department of Blood Group Serology and Transfusion Medicine; Medical University Vienna; Waehringer Guertel 18-20 A-1090 Vienna Austria
| | - V. Compernolle
- Belgian Red Cross-Flanders; Blood Services; Ottergemsesteenweg 413 B-9000 Ghent Belgium
| | - J.M. Kutner
- Hospital Israelita Albert Einstein; Av. Albert Einstein, 627 - Banco de Sangue 05651-901 Sao Paulo SP Brazil
| | - A.P.H. Yokoyama
- Hospital Israelita Albert Einstein; Av. Albert Einstein, 627 - Banco de Sangue 05651-901 Sao Paulo SP Brazil
| | - S. Nahirniak
- Department of Laboratory Medicine and Pathology; University of Alberta; 4B1.23 WMC 8440-112 St. Edmonton AB T6G 2B7 Canada
| | - M. Germain
- Medical Affairs; Héma-Québec; 1070 Sciences-de-la-Vie Ave Québec QC G1V 5C3 Canada
| | - H. Hume
- Département de Pédiatrie; Université de Montréal Service d'Hématologie/Oncologie; CHU Sainte-Justine 3175 Côte-Sainte-Catherine Montréal QC H3T 1C5 Canada
| | - N. Robitaille
- Département de Pédiatrie; Université de Montréal Service d'Hématologie/Oncologie; CHU Sainte-Justine 3175 Côte-Sainte-Catherine Montréal QC H3T 1C5 Canada
| | - A. Wilson
- Department of Hematology; McGill University Health Centre; 1001 Boul. Décarie Montréal QC Canada
| | - A. Tinmouth
- Benign Hematology and Transfusion Medicine; Ottawa Hospital and Ottawa Hospital Research Institute; 501 Smyth Rd Box 201a Ottawa ON K1H 8L6 Canada
| | - E. Massey
- Benign Hematology and Transfusion Medicine; Ottawa Hospital and Ottawa Hospital Research Institute; 501 Smyth Rd Box 201a Ottawa ON K1H 8L6 Canada
| | - C. Boulat
- Etablissement Français du Sang; 20 Avenue du Stade de France 93218 La Plaine St Denis Cedex France
| | - G. Woimant
- Etablissement Français du Sang; 20 Avenue du Stade de France 93218 La Plaine St Denis Cedex France
| | - P. Tiberghien
- Etablissement Français du Sang; 20 Avenue du Stade de France 93218 La Plaine St Denis Cedex France
| | - T. J. Schulze
- Institute of Transfusion Medicine and Immunology; Medical Faculty Mannheim; Heidelberg University; German Red Cross Blood Service Baden-Württemberg - Hessen Friedrich-Ebert-Str. 107 68167 Mannheim Germany
| | - J. Bux
- University of Bochum; Linnenkamp 19 Hagen 58093 Germany
| | - L. Pierelli
- Transfusion Medicine and Stem Cells; San Camillo Forlanini Hospital; Circonvallazione Gianicolense 87 00152 Rome Italy
| | - C. Ballester
- Department Hematology and Hemotherapy; Son Espases University Hospital; Carretera de Valldemossa 79 07010 Palma de Mallorca Spain
| | - T. Netelenbos
- Internist-hematologist and transfusion specialist; Department of Immunohematology and Blood Transfusion, E3Q; Leids University Medical Center; Postbus 9600 2300RC Leiden The Netherlands
| | - K. A. West
- Department of Transfusion Medicine; National Institutes of Health Clinical Center; 10 Center Drive Room 1N226 Bethesda MD 20892 USA
| | - C. Conry-Cantilena
- Blood Services Section; NIH/CC/DTM; Building 10 Room 1C711 Bethesda MD 20892 USA
| | - A. Eder
- Blood Services Section; NIH/CC/DTM; Building 10 Room 1C711 Bethesda MD 20892 USA
| | - N. R. Haley
- Bloodworks Northwest; Medical Services; 921 Terry Avenue Seattle WA 98104 USA
| | - M. Yazer
- University of Pittsburgh; Pittsburgh; PA USA
- University of Southern Denmark; Odense Denmark
| | - D. Triulzi
- Division of Transfusion Medicine; Department of Pathology; University of Pittsburgh Pittsburgh PA USA
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Granulocyte transfusions: A concise review for practitioners. Cytotherapy 2017; 19:1256-1269. [PMID: 28916227 DOI: 10.1016/j.jcyt.2017.08.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 01/05/2023]
Abstract
Granulocyte transfusions (GTXs) have been used to treat and prevent infections in neutropenic patients for more than 40 years, despite persistent controversy regarding their efficacy. This narrative review attempts to complement recent systematic reviews by the Cochrane Collaboration and provide both historical context and critical assessment of the most significant clinical studies published over the years. The data suggest that properly collected and promptly infused granulocytes are active against infections, both bacterial and fungal. The most important question that remains unanswered is in which patients the administration of granulocytes will be beneficial. The preponderance of evidence suggests that granulocyte transfusions may be efficacious in few select cases as a temporizing measure to control an infection that is expected (or proven) to be refractory to optimal antimicrobial treatment, and that could otherwise be controlled by marrow recovery, which is expected to happen. In this regard, they are best considered a "bridge" that grants enough time for the recipient to develop their own response to the infection. The challenges to use GTXs successfully are both clinical, in terms of timely identifying the patients who may benefit, and logistical, in terms of optimal selection of donors and collection technique.
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Abstract
Bacterial and fungal infections continue to be a major cause of morbidity and mortality in severely neutropenic patients undergoing aggressive chemotherapy regimens or hematopoietic stem cell transplantation. Traditional granulocyte transfusion therapy, a logical approach in treating these infections, has been available for many years, and several controlled studies have shown this therapy to be useful. However, granulocyte transfusion therapy fell out of favor because the results were not clinically impressive, and adverse results were reported. These disappointing results were felt to be, in part, because of the low doses of granulocytes provided. More recent studies have attempted to increase the numbers of transfused cells by stimulating normal granulocyte donors with G-CSF (+/-corticosteroids). With these techniques, the number of granulocytes transfused can be increased 3-4 fold. The cells have been shown to circulate in recipients, and daily transfusions are capable of maintaining normal or near-normal blood neutrophil counts in previously severely neutropenic patients. The cells appear to function normally by a variety of in vitro and in vivo tests. Clinical benefit, as defined by survival or clearance of infection, has not been definitively determined. Results of an ongoing randomized controlled clinical trial should be available in the near future.
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Affiliation(s)
- Anthony A. Marfin
- Puget Sound Blood Center, Seattle, WA, USA
- Current Address: HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas H. Price
- Puget Sound Blood Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
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Thorausch K, Schulz M, Bialleck H, Luxembourg B, Seifried E, Bonig H. Granulocyte collections: comparison of two apheresis systems. Transfusion 2013; 53:3262-8. [DOI: 10.1111/trf.12197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/04/2013] [Accepted: 02/21/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Kristin Thorausch
- German Red Cross Blood Service and Institute for Transfusion Medicine and Immunohematology; Goethe University Medical School; Frankfurt Germany
- Department of Medicine/Hematology; University of Washington; Seattle WA
| | - Miriam Schulz
- German Red Cross Blood Service and Institute for Transfusion Medicine and Immunohematology; Goethe University Medical School; Frankfurt Germany
- Department of Medicine/Hematology; University of Washington; Seattle WA
| | - Heike Bialleck
- German Red Cross Blood Service and Institute for Transfusion Medicine and Immunohematology; Goethe University Medical School; Frankfurt Germany
- Department of Medicine/Hematology; University of Washington; Seattle WA
| | - Beate Luxembourg
- German Red Cross Blood Service and Institute for Transfusion Medicine and Immunohematology; Goethe University Medical School; Frankfurt Germany
- Department of Medicine/Hematology; University of Washington; Seattle WA
| | - Erhard Seifried
- German Red Cross Blood Service and Institute for Transfusion Medicine and Immunohematology; Goethe University Medical School; Frankfurt Germany
- Department of Medicine/Hematology; University of Washington; Seattle WA
| | - Halvard Bonig
- German Red Cross Blood Service and Institute for Transfusion Medicine and Immunohematology; Goethe University Medical School; Frankfurt Germany
- Department of Medicine/Hematology; University of Washington; Seattle WA
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Kolovratova V, List J, Worel N, Jilma P, Leitner G. Administration of Prednisolone intravenously or Dexamethason orally in random donors reveals equal results in granulocyte collection: a single centre experience. Vox Sang 2011; 103:75-8. [DOI: 10.1111/j.1423-0410.2011.01567.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Booth GS. Transfusion medicine illustrated. Apheresis granulocytes: light microscopic changes at time of outdate and beyond. Transfusion 2011; 51:2267-8. [PMID: 22023183 DOI: 10.1111/j.1537-2995.2011.03361.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Garrett S Booth
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
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Amrein K, Valentin A, Lanzer G, Drexler C. Adverse events and safety issues in blood donation--a comprehensive review. Blood Rev 2011; 26:33-42. [PMID: 21996651 DOI: 10.1016/j.blre.2011.09.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although blood donation is generally safe, a variety of risks and complications exist, the most common being iron deficiency, vasovagal reactions and citrate-related events. In the last decades, extensive efforts have significantly improved recipient and product safety, but there is still great potential to optimise donor care. Many therapies in modern medicine depend on the prompt availability of blood products, therefore it is crucial to maintain a motivated and healthy donor pool in view of a limited number of healthy volunteers willing and able to give blood or blood components. We present a comprehensive review on adverse events addressing all types of blood donation including whole blood, plasma, platelet, peripheral blood stem cell, leucocyte and bone marrow donation. In addition, we outline strategies for the prevention and treatment of these events and give a blueprint for future research in this field.
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Affiliation(s)
- Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.
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