DETERMINANTS OF THE EFFICACY OF PROPHYLACTIC GRANULOCYTE TRANSFUSIONS- A METAANALYSIS

BACKGROUND: Cytokines that improve granulocyte collection yields have recently become available, and may lend to a new series of trials of g ranulocyte transfusion (GTX) therapy. We conducted a meta-analysis of studies of prophylactic GTX in order to identify the determinants of e fficacy of this intervention, and to assist in thr design of future tr ials of GTX for the treatment of patients with overwhelming infection. METHODS: Randomized controlled trials of the efficacy of prophylactic GTX published in English in 1970-1995 were retrieved, and eight studi es were eligible for analysis. Summary relative odds (RR) of bacterial or fungal infection, death, or death from infection in transfused pat ients vs. controls were computed for patient subsets defined on the ba sis of dose of granulocytes transfused, assessment of leukocyte compat ibility, duration of neutropenia, and infection rate of controls. The random-effects method was used for all analyses. RESULTS: Assessment o f leukocyte compatibility prior to the transfusion, dose of granulocyt es transfused, and duration of neutropenia in enrolled patients could account. respectively, for the variation in findings across published reports in terms of all three, two, and one of the outcome measures st udied. Transfusion of adequate doses of compatible leukocytes signific antly reduced the relative risk (RR) of infection, death, and death fr om infection in transfused patients vs, controls (RR) - 0.075, RR = 0. 224, and RR = 0.168, respectively; P < 0.05). CONCLUSION: Two necessar y elements in the design of future trials of therapeutic GTX should be the transfusion of high doses of granulocytes and the provision of le ukocytes that are crossmatch-compatible with the recipient's serum. (C ) 1997 Wiley-Liss, Inc.