GRANULOCYTE TRANSFUSIONS - EFFICACY IN TREATING FUNGAL-INFECTIONS IN NEUTROPENIC PATIENTS FOLLOWING BONE-MARROW TRANSPLANTATION

Background: A retrospective study was conducted to evaluate the effica cy of granulocyte transfusions in neutropenic patients with fungal inf ections following bone marrow transplantation. Study Design and Method s: Systemic fungal infection was detected in 87 patients during the fi rst 100 days following bone marrow transplantation; 50 received granul ocytes in addition to appropriate antifungal agents. The median age wa s 17 years in the transfused patients (range, 1.5-57) and 35 years in the nontransfused patients (range, 0.8-50). Granulocyte transfusions w ere given on a daily to twice-daily basis. To evaluate their responses , patients were categorized by infection type (candidal [n = 381 vs. n oncandidal [n = 491) and site (fungemia alone [n = 30] vs. invasive in fection [n = 57]). Resolution of infection was defined as the resoluti on of signs and symptoms and negative cultures and/or histopathology. Results: No benefit of granulocyte transfusions could be shown in the resolution of infection in patients with either invasive noncandidal i nfection (29% in the transfused patients vs. 23% in the nontransfused patients, p>0.1) or candidal sepsis (56% vs. 50%, p>0.1). Among patien ts with delayed marrow recovery, no difference was seen in the resolut ion of infection in the transfused (25.9%) and nontransfused (50%) pat ients (p>0.1); nor was any difference between the transfused and nontr ansfused patients evident in the duration of febrile episode associate d with the fungal infection. Granulocyte transfusions were well tolera ted, with the only complications being fever in 12 patients (24%), chi lls in 10 (20%), and respiratory distress in 2 (4%). Despite attempts to stratify by infection type, invasiveness, and marrow recovery, it w as not possible to show any benefit of granulocyte transfusions in thi s group. Conclusions: It is likely that only through a prospective ran domized trial can the question of the efficacy of granulocyte transfus ions in treating fungal infections be conclusively answered.