Mielecka-Jarmocik Gabriela, Szymbor Katarzyna, Balwierz Walentyna, Skoczeń Szymon, Leń Marta, Kania Kinga, Pawińska-Wąsikowska Katarzyna
Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland.
Department of Pediatric Oncology and Hematology, University Children Hospital of Krakow, 30-663 Krakow, Poland.
J Pers Med. 2024 Nov 15;14(11):1107. doi: 10.3390/jpm14111107.
Infections remain the leading cause of mortality among neutropenic patients with haematologic malignancies, making effective infection management crucial. Achieving a sufficient neutrophil count is essential for the elimination of pathogens. Granulocyte concentrate (GC) can be a treatment option for neutropenic patients with severe infections. This study aimed to evaluate the efficacy, safety, and impact on survival of GC transfusions in neutropenic children with severe infections treated over the past 13 years in a single centre. The retrospective study analysed clinical data from 60 children (median age 9.5 years) who received GC transfusions at our centre. Granulocytes were collected by apheresis from donors stimulated with granulocyte colony-stimulating factor. The majority of the patients (70%) were diagnosed with acute leukaemia. The main indications for GC were severe pneumonia (45%) and bacterial sepsis (38.33%). The patients received 1 to 29 GC transfusions for 1 to 70 days, with a median time of administration of 3 days. Neutrophil counts increased to >1000/µL within a median of 5 days. GCs were well tolerated by most patients. One patient presented symptoms of anaphylaxis, the other acute lung injury related to transfusions, and alloimmunisation was reported in one patient. Of the patients analysed, 78.33% survived the infection that justified GC administration. We did not observe significant differences in survival depending on the aetiology of the infection. Based on our research, GC appears to be a beneficiary for neutropenic children with severe infections and reduces infection mortality rates. However, further well-designed randomised trials are needed to define its role in this setting.
感染仍然是血液系统恶性肿瘤中性粒细胞减少患者死亡的主要原因，因此有效的感染管理至关重要。实现足够的中性粒细胞计数对于消除病原体至关重要。粒细胞浓缩物（GC）可以作为严重感染的中性粒细胞减少患者的一种治疗选择。本研究旨在评估在单一中心过去13年中接受治疗的严重感染的中性粒细胞减少儿童中，GC输血的疗效、安全性及对生存的影响。这项回顾性研究分析了在我们中心接受GC输血的60名儿童（中位年龄9.5岁）的临床数据。通过血细胞分离术从用粒细胞集落刺激因子刺激的供体中采集粒细胞。大多数患者（70%）被诊断为急性白血病。GC的主要适应证为严重肺炎（45%）和细菌性败血症（38.33%）。患者接受了1至29次GC输血，持续1至70天，中位给药时间为3天。中性粒细胞计数在中位5天内增加到>1000/µL。大多数患者对GC耐受性良好。1例患者出现过敏反应症状，另1例出现与输血相关的急性肺损伤，1例患者报告发生同种免疫。在分析的患者中，78.33%在因GC给药而引发的感染中存活下来。我们没有观察到根据感染病因在生存方面的显著差异。基于我们的研究，GC似乎对严重感染的中性粒细胞减少儿童有益，并降低了感染死亡率。然而，需要进一步设计良好的随机试验来确定其在这种情况下的作用。
