Rebirth of granulocyte transfusions: Should it involve pediatric oncology and transplant patients?

Several methodologic advances, particularly use of recombinant granulocyte colony stimulating factor to stimulate donors. have made it possible to col lect extraordinarily large numbers of normal neutrophils for transfusion in to neutropenic patients with Life-threatening infections. Because larger do ses of neutrophils can be transfused, renewed interest has arisen in the us e of neutrophil (granulocyte) transfusions to treat adult oncology patients and progenitor cell transplant recipients, in whom neutropenia complicated by severe infections persists as a significant problem, despite combinatio n antibiotic therapy, recombinant cytokines, myeloid growth factors, and us e of mobilized peripheral blood progenitor cells. In this commentary, consi deration is given as to whether pediatric oncology and transplant patients might benefit from modern,granulocyte transfusion therapy. If children are found to experience significant morbidity or mortality from neutropenic inf ections despite modem supportive care, it is logical to explore the efficac y, potential toxicity, and cost-effectiveness of granulocyte transfusion th erapy by properly designed, randomized clinical trials.