G-CSF STIMULATED DONOR GRANULOCYTE COLLECTIONS FOR PROPHYLAXIS AND THERAPY OF NEUTROPENIC SEPSIS

Background: The administration of granulocyte colony-stimulating facto r (G-CSF) increases the granulocyte count in normal donors and enables the collection of large numbers of mature myeloid cells by leukaphere sis. This has potential value in the treatment of sepsis unresponsive to antibiotics in patients with severe neutropenia. Aim: To evaluate t he tolerability of granulocyte collections in normal donors receiving G-CSF, the optimal method of collection and the clinical factors influ encing the efficacy of granulocyte infusions. Methods: Analysis of the outcome of 55 granulocyte collections from 26 donors for progressive bacterial or fungal sepsis in neutropenic patients (n=8) or as prophyl axis in patients with recent fungal infections undergoing allogeneic b one marrow transplantation (BMT) (n=3). Results: G-CSF was well tolera ted in most donors. Fatigue occurred commonly after the second collect ion. The median WCC per 200-220 mt bag was 351x10(9)/L. Collections we re optimised with the use of a sedimenting agent (dextran) and a deepe ned interface setting on the cell separator. There was only a weak cor relation between the number of granulocytes infused and the increment in the patient, but levels were usually maintained greater than or equ al to 0.5x10(9)/L for the next 24 hours. The infusions were successful in three septic patients without multi-organ dysfunction and prophyla ctically, in two patients with localised fungal infections undergoing MET. The infusions were not beneficial in patients with septicaemia an d established organ dysfunction or with extensive pulmonary aspergillo sis. Conclusions: G-CSF mobilised granulocyte collections are feasible and the preliminary evidence suggests that the infusion of these cell s may be useful early in the prophylaxis or treatment of severe neutro penic sepsis.