Atallah Ehab, Schiffer Charles A
Divison of Hematology/Oncology, Karmanos Cancer Institute, Detroit, Michigan 48201, USA.
Curr Opin Hematol. 2006 Jan;13(1):45-9. doi: 10.1097/01.moh.0000190114.38650.b2.
Granulocyte transfusions have been used for more than four decades. Several issues have complicated the analysis of previous studies, including the utilization of improved antimicrobials, the effects of recipient alloimmunization and variable cell dose. The use of granulocyte colony-stimulating factor for donor stimulation has revived interest in granulocyte transfusion. The aim of this review is to evaluate the most recent studies in granulocyte transfusion therapy and their clinical applicability.
Granulocyte colony-stimulating factor use has increased the granulocyte yield by approximately fourfold. Multiple recent studies have shown that granulocyte transfusions can be helpful in controlling severe infections progressing despite the use of appropriate antibiotics, with a response rate of 40-80% with variability in results depending on patient characteristics. This benefit is limited to a small patient population as the incidence of prolonged reversible neutropenia is relatively small. Severe side effects have been rare in those studies.
Granulocyte transfusions are beneficial in neutropenic patients with severe uncontrolled infection. The underlying disease process is the major determinant of outcome in these patients. Because granulocyte transfusions are not commonly used, centers are not currently able to provide transfusions in a timely fashion. Nonalloimmunized patients can receive cells from nonmatched ABO compatible donors, while alloimmunized patients should receive granulocytes from either HLA-matched donors or donors selected by leukoagglutination or lymphocytotoxicity crossmatching. Further studies are needed to clarify the optimal starting time and frequency of transfusions, and the best method for identifying donor-recipient compatibility.
粒细胞输注已应用四十多年。此前的研究分析存在几个复杂问题，包括改进型抗菌药物的使用、受者同种免疫的影响以及细胞剂量的差异。使用粒细胞集落刺激因子刺激供者使得人们对粒细胞输注重新产生兴趣。本综述的目的是评估粒细胞输注治疗的最新研究及其临床适用性。
使用粒细胞集落刺激因子使粒细胞产量增加了约四倍。最近的多项研究表明，尽管使用了适当的抗生素，但粒细胞输注有助于控制仍在进展的严重感染，根据患者特征不同，有效率为40% - 80%，结果存在差异。由于长期可逆性中性粒细胞减少的发生率相对较低，这种益处仅限于一小部分患者群体。在这些研究中，严重副作用很少见。
粒细胞输注对患有严重未控制感染的中性粒细胞减少患者有益。潜在的疾病进程是这些患者预后的主要决定因素。由于粒细胞输注不常用，目前各中心无法及时提供输注。未发生同种免疫的患者可接受来自ABO血型不相容但相容供者的细胞，而发生同种免疫的患者应接受来自HLA匹配供者或通过白细胞凝集或淋巴细胞毒性交叉配型选择的供者的粒细胞。需要进一步研究以明确输注的最佳起始时间和频率，以及确定供者 - 受者相容性的最佳方法。
