TREATMENT OF NEUTROPENIA-RELATED FUNGAL-INFECTIONS WITH GRANULOCYTE-COLONY-STIMULATING FACTOR-ELICITED WHITE BLOOD-CELL TRANSFUSIONS - A PILOT-STUDY

Neutropenia-related fungal infections can be life-threatening despite antifungal therapy. We evaluated the role of recombinant granulocyte c olony-stimulating factor (rG-CSF)-elicited white blood cell (WBC) tran sfusions in patients with neutropenia-related fungal infections. Adult patients with hematologic malignancies, absolute neutrophil counts (A NC) <500/mu l and fungal infections refractory to amphotericin B, rece ived daily transfusions of rG-CSF-elicited and irradiated WBC transfus ions from related donors. Donors received 5 mu g/kg/day of rG-CSF subc utaneously. Donors achieved a mean ANC of 29.4 x 10(3) per microliter. The mean yield of neutrophils per transfusion was 41 x 10(9) (range, 10-116). Fifteen patients received a median of eight transfusions (ran ge, 3-16). Fourteen patients had received rG-CSF for a median of 12 da ys. The median ANC baseline was 20/mu l. Eleven patients had favorable responses and eight of them remained free of infection 3 weeks after therapy. Favorable responses occurred among patients with better Zubro d performance status (median, 3 vs 4) and shorter duration of both pro found neutropenia (median, 15 vs 25 days) and active infection (median , 8 vs 17 days). The mean 1- and 24-h post-transfusion ANCs were 594/m u l (range, 98-1472/mu l) and 396/mu l (range, 50-1475/mu l), respecti vely. Adverse reactions were observed in nine of 35 donors and in the recipients of six of 130 transfusions. rG-CSF-elicited WBC transfusion s may be a safe and promising approach for treating neutropenia-relate d fungal infections.