Phase I/II trial of neutrophil transfusions from donors stimulated with G-CSF and dexamethasone for treatment of patients with infections in hematopoietic stem cell transplantation

We examined the feasibility of a community blood bank granulocyte transfusi on program utilizing community donors stimulated with a single-dose regimen of subcutaneous granulocyte colony-stimulating factor (G-CSF) plus oral de xamethasone, The recipients of these transfusions were neutropenic stem cel l transplantation patients with severe bacterial or fungal infection. Ninet een patients received 165 transfusions (mean 8.6 transfusions/patient, rang e 1-25). Community donors provided 94% of the transfusions; relatives accou nted for only 6% of the transfusions. Sixty percent of the community donors initially contacted agreed to participate, and 98% of these individuals in dicated willingness to participate again. Transfusion of 81.9 +/- 2.3 x 10( 9) neutrophils (mean +/- SD) resulted in a mean 1-hour posttransfusion neut rophil increment of 2.6 +/- 2.6 x 10(3)/mu L and restored the peripheral ne utrophil count to the normal range in 17 of the 19 patients. The buccal neu trophil response, a measure of the capacity of neutrophils to migrate to ti ssue sites in vivo, was restored to normal in most patients following the t ransfusion. Chills, fever, and arterial oxygen desaturation of greater than or equal to 3% occurred in 7% of the transfusions, but these changes were not sufficient to limit therapy. Infection resolved in 8 of 11 patients wit h invasive bacterial infections or candidemia, These studies indicate that transfusion of neutrophils from donors stimulated with G-CSF plus dexametha sone can restore a severely neutropenic patient's blood neutrophil supply a nd neutrophil inflammation response. Further studies are needed to evaluate the clinical efficacy of this therapy. (Blood, 2000; 95:3302-3309) (C) 200 0 by The American Society of Hematology.