WBC-reduced blood transfusions and clinical outcome in children with acutelymphoid leukemia

BACKGROUND: WBC reduction offers a variety of benefits to patients requirin g multiple transfusions during induction therapy for childhood acute lympho id leukemia (ALL), including reductions in febrile transfusion reactions, H LA alloimmunization, and CMV transmission. One potential benefit is a reduc tion in the deleterious effects of transfusion immunomodulation. In the sur gical setting, transfusion immunomodulation has been linked to increases in postoperative infections and decreases in host cellular immunity that are mitigated by WBC reduction of transfused blood. STUDY DESIGN AND METHODS: A retrospective review was conducted of the medic al records of 68 consecutive children undergoing induction therapy for newl y diagnosed ALL from 1988 through 1995, a period whose midpoint is 1991, th e year WBC reduction was introduced in this hospital. RESULTS: WBC reduction of platelet and RBC transfusions was associated with fewer days with fever (mean, 5.7 days [no WBC reduction] and 2.1 days [WBC reduction]; p = 0.012) and days with positive microbial cultures (mean, 1. 5 [no WBC reduction] and 0.71 [WBC reduction]; p = 0.0055). There were more high-risk ALL patients in the group receiving WBC-reduced transfusions. CONCLUSION: Allogeneic WBCs in transfused blood may cause impairment of hos t defenses against microbial infection during induction therapy for childho od ALL.