Clinical related efficacy of granulocyte transfusion therapy in patients with neutropenia-infections

Granulocyte transfusions have been advocated by some for the treatment of s evere, progressive infections in neutropenic patients who fail to respond t o antimicrobial agents and recombinant hematopoietic growth factors. We con ducted the current study to determine an appropriate method of granulocyte mobilization in healthy donors, and to evaluate the safety and efficacy of granulocyte transfusion therapy in patients with neutropenia-related infect ions. To mobilize granulocytes (n = 55), healthy normal donors were stimula ted in one of the following ways: (1) dexamethasone, 3 mg/m(2) intravenousl y 15 min prior to leukapheresis (n = 5); (2) granulocyte colony-stimulating factor (G-CSF), 5 mug/kg subcutaneously 12 to 14 h prior to collection (n = 37); or (3) G-CSF and dexamethasone (n = 13), The mean granulocyte yield from stimulation with G-CSF plus dexamethasone was significantly higher tha n from stimulation with dexamethasone or G-CSF alone. Twenty-five patients with severe neutropenia-related infections unresponsive to appropriate anti microbial agents received a total of 55 granulocyte transfusions. The patie nts from whom fungi or Gram-negative organisms were isolated showed a more favorable response than those infected with Gram-positive organisms. Howeve r, the responses to the granulocyte transfusion therapy could not be correl ated with the transfused dose, mobilization agents, or the 1 h or 24 h post -transfusion absolute neutrophil counts. We conclude that granulocyte trans fusion therapy may be clinically useful for neutropenia-related infections by fungi or Gram-negative organisms.