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儿科血液肿瘤患者危及生命的感染早期使用粒细胞输注:单中心经验。

Use of granulocyte transfusion in early period in life-threatening infections of pediatric hematology and oncology patients: A single-center experience.

机构信息

University of Health Sciences, Umraniye Training and Research Hospital, Department of Pediatric Hematology-Oncology, Turkey.

University of Health Sciences, Umraniye Training and Research Hospital, Department of Pediatric Hematology-Oncology, Turkey.

出版信息

Transfus Apher Sci. 2021 Aug;60(4):103134. doi: 10.1016/j.transci.2021.103134. Epub 2021 Apr 8.

DOI:10.1016/j.transci.2021.103134
PMID:33858754
Abstract

Despite all the developments in medicine, infections continue to be one of the most important causes of mortality in pediatric hematology and oncology patients. The more severe the degree of neutropenia develops after intensive chemotherapy in cancer patients, and the longer the neutropenia duration, the higher the risk of infection. Granulocyte transfusion (GT) is used as supportive therapy in cases where the bone marrow needs time to recover in invasive bacterial or fungal infections along with severe neutropenia. The patients who had granulocyte transfusions in our clinic between June 2019 and June 2020 were reviewed retrospectively. A total of 15 units of granulocyte concentrate were used in 11 febrile neutropenia attacks of 9 patients. The demographic characteristics of the patients and features belonging to the period of GT were recorded. In our study, the clinical response rate after GT was 90.9 %, while the hematological response rate was 40 %. Most of the patients were treated succesfully, the mortality rate was 9%. We think that the most critical factor for success with GTs is determining the neutropenic patient in particular with a combination of high-risk malignancy and acute life-threatening infection for using GT. Also, early use of GT in those patients who do not recover despite appropriate antimicrobial and supportive treatment may contribute to improvement of the clinical conditon in a shorter period of time and reduction of repeated GTs.

摘要

尽管医学有了所有的发展,感染仍然是儿科血液学和肿瘤学患者死亡的最重要原因之一。癌症患者在强化化疗后中性粒细胞减少的程度越严重,中性粒细胞减少持续的时间越长,感染的风险就越高。在侵袭性细菌或真菌感染以及严重中性粒细胞减少症的情况下,骨髓需要时间恢复时,粒细胞输注(GT)被用作支持治疗。回顾性分析了 2019 年 6 月至 2020 年 6 月在我院接受粒细胞输注的患者。9 例发热性中性粒细胞减少症发作中,共使用了 15 单位粒细胞浓缩物。记录了患者的人口统计学特征和 GT 期间的特征。在我们的研究中,GT 后的临床反应率为 90.9%,而血液学反应率为 40%。大多数患者都成功治疗,死亡率为 9%。我们认为,GT 成功的最关键因素是确定特定的中性粒细胞减少症患者,特别是具有高危恶性肿瘤和急性危及生命的感染,以使用 GT。此外,对于那些尽管进行了适当的抗菌和支持治疗但仍未恢复的患者,早期使用 GT 可能有助于在更短的时间内改善临床状况并减少重复 GT。

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