The effect of granulocyte transfusion on engraftment in patients with allogeneic hematopoietic stem cell transplantation

Yıl 2023, Cilt: 6 Sayı: 3, 674 - 679, 31.05.2023

Yeşim İtmeç , Serhat Çelik , Ali Ünal

https://doi.org/10.32322/jhsm.1275159

Öz

Aim: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still one of the most effective treatments for many hematological malignancies. However, especially infections and neutropenic fever increase mortality during the engraftment development process after allo-HSCT. This study investigated the effect and safety profile of granulocyte transfusion (GT) on engraftment in patients with neutropenic fever after allo-HSCT.
Material and Method: We investigated 32 patients with hematological malignancies who had neutropenic fever following allo-HSCT between June 2018 and February 2020. Seventeen patients were given GT and defined as GT group (GTG). GT was given once daily until improvement in clinical and laboratory parameters (neutrophil >0.5 ×10³/µL, platelet >20 ×10³/µL). Fifteen patients who did not receive GT were included as a control group (CG).
Results: By comparing leukocyte levels between the start and end of GT, the median leukocyte increase was shown as 1.93 (0.37- 10.21) ×10³/µL (p=0.001). Similarly, the median neutrophil increase was 1.14 (0.25-9.24) ×10³/µL (p=0.001). A total of 65 GTs were administered, the average number of days was 4±1. The average dose of infused granulocyte was 4 ×1010/unit. In GTG, neutrophil and platelet engraftments occurred on average at 14±2 and 10±2 days, respectively. In CG, neutrophil and platelet engraftments occurred on average 15±2 and 12±3 days, respectively. There was no statistically significant difference in neutrophil and platelet engraftment between the two groups (p=0.4, p=0.06, respectively).
Conclusion: GT was observed to be effective in managing complications such as neutropenic fever and sepsis after allo-HSCT by shortening the duration of neutropenia and increasing neutrophil and leukocyte values. Although statistical significance was not observed in our study, it was observed that the engraftment times were shortened with GT.

Anahtar Kelimeler

Allogeneic transplantation, engraftment, granulocyte transfusion

Kaynakça

• Sachs UJ, Reiter A, Walter T, Bein G, Woessmann W. Safety and efficacy of therapeutic early onset granulocyte transfusions in pediatric patients with neutropenia and severe infections. Transfusion 2006; 46: 1909-14.
• Illerhaus G, Wirth K, Dwenger A, et al. Treatment and prophylaxis of severe infections in neutropenic patients by granulocyte transfusions. Ann Hematol 2002; 81: 273-81.
• Massey E, Paulus U, Doree C, Stanworth S. Granulocyte transfusions for preventing infections in patients with neutropenia or neutrophil dysfunction. Cochrane Database of Systematic Reviews 2009: 1.
• Bensinger W, Appelbaum F, Rowley S, et al. Factors that influence collection and engraftment of autologous peripheral-blood stem cells. J. Clin. Oncol 1995; 13: 2547-55.
• Safdar A, Rodriguez G, Zuniga J, Al Akhrass F, Pande A. Use of healthy-donor granulocyte transfusions to treat infections in neutropenic patients with myeloid or lymphoid neoplasms: experience in 74 patients treated with 373 granulocyte transfusions. Haematol 2014; 131: 50-8.
• Lee S-N, Hu Y, Eom HS, Lee H, Lee E, Kong S-Y. Analysis of granulocyte transfusions in patients with infections and neutropenia: a single center experience. Korean J Blood Transfus 2016; 27: 247-56.
• Al‐Tanbal H, Al Humaidan H, Al‐Nounou R, Roberts G, Tesfamichael K, Owaidah T. The value and practicality of granulocyte transfusion: a single oncology centre experience. Transfus Med 2010; 20: 160-8.
• Ofran Y, Avivi I, Oliven A, et al. Granulocyte transfusions for neutropenic patients with life‐threatening infections: a single centre experience in 47 patients, who received 348 granulocyte transfusions. Vox Sang 2007; 93: 363-9.
• Rutella S, Pierelli L, Piccirillo N, et al. Efficacy of granulocyte transfusions for neutropenia-related infections: retrospective analysis of predictive factors. Cytotherapy 2003; 5: 19-30.
• Price TH, Bowden RA, Boeckh M, et al. 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: Presented previously in part in abstract form at the 1997 Annual Meeting of the American Society of Hematology, San Diego, CA. Blood 2000; 95: 3302-9.
• Price TH. Granulocyte transfusion therapy: it's time for an answer. Wiley Online Library; 2006.
• Ikegawa S, Fujii N, Fujii K, et al. Granulocyte transfusions for neutropenic patients receiving allogeneic hematopoietic stem cell transplantation. B Biol Blood Marrow Transplant 2018; 24: S326.
• Lin W, Voskens CJ, Zhang X, et al. Fc-dependent expression of CD137 on human NK cells: insights into “agonistic” effects of anti-CD137 monoclonal antibodies. Blood Am J Hematol 2008; 112: 699-707.
• Lee J-M, Choi SJ, Kim HS, et al. Analysis of hematologic parameters of donors, patients, and granulocyte concentrates to predict successful granulocyte transfusion. Blood Res 2019; 54: 52-6.
• Ikemoto J, Yoshihara S, Fujioka T, et al. Impact of the mobilization regimen and the harvesting technique on the granulocyte yield in healthy donors for granulocyte transfusion therapy. Transfusion 2012; 52: 2646-52.
• Hiemstra IH, van Hamme JL, Janssen MH, van den Berg TK, Kuijpers TW. Dexamethasone promotes granulocyte mobilization by prolonging the half‐life of granulocyte–colony‐stimulating factor in healthy donors for granulocyte transfusions. Transfusion 2017; 57: 674-84.
• Ang A, Linn Y. Treatment of severe neutropenic sepsis with granulocyte transfusion in the current era–experience from an adult haematology unit in Singapore. Transfus Med 2011; 21: 13-24.