Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan; Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan.
Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan; Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan.
Transfus Apher Sci. 2022 Dec;61(6):103453. doi: 10.1016/j.transci.2022.103453. Epub 2022 May 10.
Active infection at the time of allogeneic hematopoietic stem cell transplantation (HSCT) is a risk for non-relapse mortality (NRM) after HSCT. Granulocyte transfusion (GTX) has been used to prevent or treat life-threatening infections in patients with severe neutropenia. However, data are limited on the clinical benefits of GTX during HSCT. We retrospectively analyzed the transplant outcomes of HSCT patients who had undergone GTX between 2012 and 2020. Altogether, 20 patients with documented infection had received 55 GTXs during HSCT. No adverse events were observed during the GTX infusion. The average number of granulocytes was 0.40 (range, 0.10-1.59) × 10/kg. The median neutrophil increment one day after GTX was 515 (range, -6 to 6630)/μl, which was significantly correlated with the infused granulocyte dose (p = 0.0007). A total of 17 of 20 patients achieved neutrophil engraftment. The number of infused granulocytes tended to higher in clinical responders (p = 0.12), and patients receiving ≥ 0.5 × 10/kg showed trend toward to better transplant outcomes (GTX-high vs. GTX-low, 1-year OS; 33% vs. 11%, p = 0.19. 1-year NRM; 44% vs.77%, p = 0.11). The type of red blood sedimenting agents was significantly correlated with the amounts of granulocyte collection. In conclusion, GTX, especially with a high amount of containing granulocytes, could be a safe bridging therapy for neutrophil engraftment after HSCT in patients with active infection.
异基因造血干细胞移植（HSCT）时的活动性感染是 HSCT 后非复发死亡率（NRM）的危险因素。粒细胞输注（GTX）已被用于预防或治疗严重中性粒细胞减少症患者的危及生命的感染。然而，关于 GTX 在 HSCT 期间的临床获益的数据有限。我们回顾性分析了 2012 年至 2020 年间接受 GTX 的 HSCT 患者的移植结果。共有 20 例有记录的感染患者在 HSCT 期间接受了 55 次 GTX。在 GTX 输注过程中未观察到不良事件。平均输注的粒细胞数为 0.40（范围，0.10-1.59）×10/kg。GTX 后一天的中性粒细胞增量中位数为 515（范围，-6 至 6630）/μl，与输注的粒细胞剂量显著相关（p=0.0007）。20 例患者中有 17 例达到了中性粒细胞植入。临床反应者输注的粒细胞数倾向更高（p=0.12），并且接受≥0.5×10/kg 粒细胞的患者显示出更好的移植结果的趋势（GTX-高与 GTX-低，1 年 OS；33%与 11%，p=0.19；1 年 NRM；44%与 77%，p=0.11）。红细胞沉降剂的类型与粒细胞采集量显著相关。总之，GTX，特别是含有大量粒细胞的 GTX，可能是活动性感染患者 HSCT 后中性粒细胞植入的一种安全的桥接治疗方法。
