Lee J J, Chung I J, Park M R, Kook H, Hwang T J, Ryang D W, Kim H J
Department of Internal Medicine, Chonnam National University Medical School, Kwangju, South Korea.
Leukemia. 2001 Feb;15(2):203-7. doi: 10.1038/sj.leu.2402007.
Granulocyte transfusions have been advocated by some for the treatment of severe, progressive infections in neutropenic patients who fail to respond to antimicrobial agents and recombinant hematopoietic growth factors. We conducted 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 infections. To mobilize granulocytes (n=55), healthy normal donors were stimulated in one of the following ways: (1) dexamethasone, 3 mg/m2 intravenously 15 min prior to leukapheresis (n = 5); (2) granulocyte colony-stimulating factor (G-CSF), 5 microg/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 than from stimulation with dexamethasone or G-CSF alone. Twenty-five patients with severe neutropenia-related infections unresponsive to appropriate antimicrobial agents received a total of 55 granulocyte transfusions. The patients from whom fungi or Gram-negative organisms were isolated showed a more favorable response than those infected with Gram-positive organisms. However, the responses to the granulocyte transfusion therapy could not be correlated with the transfused dose, mobilization agents, or the 1 h or 24 h post-transfusion absolute neutrophil counts. We conclude that granulocyte transfusion therapy may be clinically useful for neutropenia-related infections by fungi or Gram-negative organisms.
对于那些对抗菌药物和重组造血生长因子无反应的中性粒细胞减少患者的严重、进行性感染，一些人主张进行粒细胞输注治疗。我们开展了本研究，以确定健康供体中粒细胞动员的合适方法，并评估粒细胞输注治疗在中性粒细胞减少相关感染患者中的安全性和疗效。为了动员粒细胞（n = 55），健康正常供体通过以下方式之一进行刺激：（1）地塞米松，在白细胞分离术前15分钟静脉注射3mg/m²（n = 5）；（2）粒细胞集落刺激因子（G-CSF），在采集前12至14小时皮下注射5μg/kg（n = 37）；或（3）G-CSF和地塞米松（n = 13）。G-CSF加地塞米松刺激产生的平均粒细胞产量显著高于单独用地塞米松或G-CSF刺激产生的产量。25例对适当抗菌药物无反应的严重中性粒细胞减少相关感染患者共接受了55次粒细胞输注。分离出真菌或革兰氏阴性菌的患者比感染革兰氏阳性菌的患者反应更好。然而，粒细胞输注治疗的反应与输注剂量、动员剂或输血后1小时或24小时的绝对中性粒细胞计数无关。我们得出结论，粒细胞输注治疗对于真菌或革兰氏阴性菌引起的中性粒细胞减少相关感染可能具有临床实用性。
