Özkan Sidika Gülkan, Kimiaei Ali, Safaei Seyedehtina, Sönmezoğlu Meral, Özkan Hasan Atilla
Hematology, Bahçeşehir University, Istanbul, TUR.
Infectious Diseases, Yeditepe University Hospital, Istanbul, TUR.
Cureus. 2024 Mar 11;16(3):e55953. doi: 10.7759/cureus.55953. eCollection 2024 Mar.
Introduction Despite the development of modern antibiotic and antifungal therapies, neutropenic infections remain life-threatening. Granulocyte transfusion (GTX) is a less frequently used treatment modality in patients with refractory neutropenic infections. The role of donor GTX remains controversial, partly because of the lack of proper clinical trials. This study aimed to contribute to the literature by evaluating the efficacy and side effects of granulocyte transfusions in our center. Methods Eight febrile neutropenic patients with confirmed infections received granulocyte transfusions from ABO-compatible related and unrelated donors. Donors received filgrastim and dexamethasone stimulation, and granulocyte suspensions were irradiated and administered within six hours. Monitoring, antibiotic therapy, and granulocyte colony-stimulating factor (G-CSF) support were maintained. Results Our study observed a 28-day survival rate of 25%, which was lower than that reported in previous literature. The median number of transfusions was 3, with an average eight-day duration post-infection diagnosis, and no side effects were observed. Conclusion While some patients benefited from GTX, overall survival rates remained modest, indicating the need for further research. Prospective, well-powered randomized controlled trials are essential to address patient selection, dosing, and duration to determine the clinical utility of GTX. This study underscores the complexity of GTX in real-world clinical practice and provides insight into the ongoing debate regarding its efficacy in treating severe neutropenic infections.
引言 尽管现代抗生素和抗真菌疗法不断发展，但中性粒细胞减少症患者的感染仍然危及生命。粒细胞输注（GTX）在难治性中性粒细胞减少症感染患者中是一种较少使用的治疗方式。供体GTX的作用仍存在争议，部分原因是缺乏适当的临床试验。本研究旨在通过评估我们中心粒细胞输注的疗效和副作用，为相关文献提供参考。方法 8例确诊感染的发热性中性粒细胞减少症患者接受了来自ABO血型相容的亲属和非亲属供体的粒细胞输注。供体接受非格司亭和地塞米松刺激，粒细胞悬液经辐照后在6小时内输注。持续进行监测、抗生素治疗和粒细胞集落刺激因子（G-CSF）支持。结果 我们的研究观察到28天生存率为25%，低于先前文献报道的生存率。输注次数中位数为3次，感染诊断后平均持续8天，未观察到副作用。结论 虽然一些患者从GTX中获益，但总体生存率仍然不高，这表明需要进一步研究。前瞻性、有足够样本量的随机对照试验对于确定患者选择、剂量和疗程以明确GTX的临床实用性至关重要。本研究强调了GTX在实际临床实践中的复杂性，并为关于其治疗严重中性粒细胞减少症感染疗效的持续争论提供了见解。
