Effect of leukocyte compatibility on neutrophil increment after transfusion of granulocyte colony-stimulating factor-mobilized prophylactic granulocyte transfusions and on clinical outcomes after stem cell transplantation

The primary limitations of granulocyte transfusions include low component c ell dose and leukocyte incompatibility. Component cell dose improved with g ranulocyte colony-stimulating factor (G-CSF) mobilization, and the transfus ion of G-CSF-mobilized, human leukocyte antigen (HLA)-matched granulocyte c omponents resulted In significant, sustained absolute neutrophil count (ANC ) increments. However, the effect of leukocyte compatibility on outcomes wi th G-CSF-mobilized granulocyte transfusions is unclear. The objectives were to determine the effect of leukocyte compatibility on ANC increments and s elected clinical outcomes after transfusion of prophylactic, G-CSF-mobilize d granulocyte components into neutropenic recipients of autologous peripher al blood stem cell (PBSC) transplants. Beginning on transplant day 2, 23 ev aluable recipients were scheduled to receive 4 alternate-day transfusions o f granulocyte components apheresed from a single donor given G-CSF, G-CSF w as also given to recipients after transplantation. Recipient ANC was determ ined before acid sequentially after each granulocyte transfusion to determi ne the peak ANC increment. Leukocyte compatibility was determined at study entry only by a lymphocytotoxicity screening assay (s-LCA) against a panel of HLA-defined cells. Eight recipients had positive s-LCA, On days 2 and 4, the mean peak ANC increments after granulocyte transfusion were comparable between the cohorts with positive and negative s-LCA, However, the mean pe ak ANC increments on day 6 (246/mu L vs 724/mu L; P = .05) and day 8 (283/m u L vs 1079/mu L; P = .06) were lower in the cohort with positive s-LCA, in spite of the transfusion of comparable component cell doses. Adverse react ions occurred with only 5 of 87 (5.7%) granulocyte transfusions and were no t associated with leukocyte compatibility test results. Platelet increments , determined 1 hour after granulocyte transfusion, were comparable between the cohorts. Although the 2 cohorts received PBSC components with similar C D34(+) cell doses, the cohort with a positive s-LCA had delayed neutrophil engraftment and a greater number of febrile days and required more days of intravenous antibiotics and platelet transfusions. Leukocyte incompatibilit y adversely affected ANC increments after the transfusion of G-CSF-mobilize d granulocyte components and clinical outcomes after PBSC transplantation. (Blood. 2000; 95:3605-3812) (C) 2000 by The American Society of Hematology.