GRANULOCYTE TRANSFUSION - STIMULATION OF LOW-DOSE GRANULOCYTE-COLONY-STIMULATING FACTOR IN DONORS FOR LEUKAPHERESIS

In order to assess the clinical utility of granulocyte transfusions (G T), the stimulating effects of donor granulopoiesis for GT therapy wer e examined using either low dose recombinant human granulocyte colony- stimulating factor (rhG-CSF) or dexamethasone (DEX). The increment of leukocytes, polymorphonuclear cells (PMN) and monocytes in the subject s stimulated with rhG-CSF (0.7 mu g/kg SC) surpassed each increment in those with DEX alone (1 mg PO). The lymphocyte counts after DEX stimu lation decreased in contrast to those after G-CSF stimulation. This do se of G-CSF did not enhance the priming effects on the superoxide rele ase from PMN. The serum levels of lysozyme, but not of lactate dehydro genase, in G-CSF stimulated donors were higher than those in DEX-treat ed donors. The serum macrophage/monocyte-colony stimulating factor (M- CSF) levels in DEX stimulation were lower than in either G-CSF stimula tion or no stimulation. The net yield of the PMN in GT on G-CSF stimul ation was practically larger than that on DEX stimulation. One of the two patients who received GT collected by DEX stimulation died of aspe rgillosis. Two of the five patients who received PMN mobilized by G-CS F died of fungal infections or necrotizing fasciitis, although two of the remaining patients overcame severe bacterial infections. These res ults suggest that low dose G-CSF effectively and safely mobilizes a su fficient quantity of PMN from GT-donors without excessive superoxide g eneration from the transfused cells. This low dose G-CSF stimulation m ay be substituted for conventional DEX stimulation for GT.