Kikuta A, Ohto H, Nemoto K, Mochizuki K, Sano H, Ito M, Suzuki H
Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima City, Japan.
Vox Sang. 2006 Jul;91(1):70-6. doi: 10.1111/j.1423-0410.2006.00776.x.
Granulocyte transfusion therapy (GTX) can be effective for life-threatening infections unresponsive to conventional antimicrobial therapies in severely neutropenic children with cancer. We developed a new granulocyte collection method, named the 'bag method', in which apheresis, hydroxyethyl starch (HES) or dexamethasone are not used. We undertook a pilot study to determine the feasibility and the safety of GTX collected by the bag method for children with cancer and life-threatening infections.
A total of 25 GTX were administered to 13 patients (median age 3 years, range: 0.3-17; median weight 10.6 kg, range: 4.5-49.8) with neutropenia-related infections. Thirteen blood-relative donors received granulocyte colony-stimulating factor (G-CSF) (5-10 microg/kg), subcutaneously, 14 h before collection. Major end-points were granulocyte yields, post-transfusion absolute neutrophil counts (ANC) in patients, donor and patient safety, and clinical outcome on day 30.
The median yield of ANC per 400 ml of processed whole blood was 6.2 x 10(9) (range: 2.5-15.0 x 10(9)). Patients received a mean of 6.4 +/- 0.8 x 10(8) granulocytes per kg of body weight per transfusion. The 1-h and 24-h post-transfusion ANC rose to 607 +/- 124/microl and 704 +/- 300/microl, respectively, from the baseline of 21/microl before the first GTX. Adverse reactions were observed in five of 13 donors (bone pain, headache, vasovagal reaction; all < or = grade 2) and in two of 25 transfusions of 13 patients (transient hypoxia; grade 3). Ten patients had favourable responses, and infection resolved in nine patients.
The bag method without apheresis relieves the physical load of donors and enables patients with a low body weight to provide an adequate dose of granulocytes.
对于患有癌症的严重中性粒细胞减少儿童，常规抗菌治疗无效的危及生命的感染，粒细胞输注疗法（GTX）可能有效。我们开发了一种新的粒细胞采集方法，称为“袋式法”，该方法不使用血液成分分离术、羟乙基淀粉（HES）或地塞米松。我们进行了一项试点研究，以确定袋式法采集的GTX用于患有癌症和危及生命感染的儿童的可行性和安全性。
共对13例（中位年龄3岁，范围：0.3 - 17岁；中位体重10.6 kg，范围：4.5 - 49.8 kg）患有中性粒细胞减少相关感染的患者进行了25次GTX输注。13名有血缘关系的供者在采集前14小时皮下注射粒细胞集落刺激因子（G - CSF）（5 - 10μg/kg）。主要终点指标为粒细胞产量、患者输血后绝对中性粒细胞计数（ANC）、供者和患者安全性以及第30天的临床结局。
每400 ml处理后的全血中ANC的中位产量为6.2×10⁹（范围：2.5 - 15.0×10⁹）。患者每次输血每千克体重平均接受6.4±0.8×10⁸个粒细胞。首次GTX输注前基线ANC为21/μl，输血后1小时和24小时分别升至607±124/μl和704±300/μl。13名供者中有5名出现不良反应（骨痛、头痛、血管迷走神经反应；均≤2级），13例患者的25次输血中有2次出现不良反应（短暂性缺氧；3级）。10例患者反应良好，9例患者感染得到缓解。
不采用血液成分分离术的袋式法减轻了供者的身体负担，使低体重患者能够提供足够剂量的粒细胞。
