GRANULOCYTE TRANSFUSION IN NEUTROPENIC PATIENTS-EBMT Educational Meeting from the Severe Aplastic Anaemia and Infectious Diseases Working Parties, Naples, Italy, 2014.

Neutropenic patients with malignancies and hematopoietic stem cell transplant recipients are prone to severe infections. Reversal of neutropenia with granulocyte transfusion (GTX) from donors stimulated with GCSF with/without steroids aims to improve outcome of infection. Cochrane analysis of randomized controlled studies, however, failed to show reduced mortality following GTX in conjunction with antibiotics. Non-randomized studies published during the last 20 years produced a very broad spectrum of results. The most important factors predicting favorable response to GTX are high number of granulocytes transfused and recovery from neutropenia. The response in patients with bad performance status, septic shock, multiple co-morbidities, multi-organ dysfunction and those in intensive care was poor. The response in fungal infections is generally worse than in bacterial infections. Cochrane analysis of prospective GTX clinical trials in preventing infection also failed to show reduced overall mortality. Adverse reactions in recipients are usually mild, although severe reactions, including respiratory deterioration, have been observed. Based on current evidence, GTX, at the amount at least 1x1010 per dose, can be considered in certain patients with severe neutropenia or congenital disorder of neutrophil function with proven or highly probable fungal or bacterial infection unresponsive to appropriate antimicrobial therapy with expected duration of neutropenia for at least 5 days; in cases where neutrophil recovery is anticipated.