Bhatia S, McCullough J, Perry E H, Clay M, Ramsay N K, Neglia J P
Division of Pediatric Hematology-Oncology, University of Minnesota, Minneapolis.
Transfusion. 1994 Mar;34(3):226-32. doi: 10.1046/j.1537-2995.1994.34394196620.x.
A retrospective study was conducted to evaluate the efficacy of granulocyte transfusions in neutropenic patients with fungal infections following bone marrow transplantation.
Systemic fungal infection was detected in 87 patients during the first 100 days following bone marrow transplantation; 50 received granulocytes in addition to appropriate antifungal agents. The median age was 17 years in the transfused patients (range, 1.5-57) and 35 years in the nontransfused patients (range, 0.8-50). Granulocyte transfusions were given on a daily to twice-daily basis. To evaluate their responses, patients were categorized by infection type (candidal [n = 38] vs. noncandidal [n = 49]) and site (fungemia alone [n = 30] vs. invasive infection [n = 57]). Resolution of infection was defined as the resolution of signs and symptoms and negative cultures and/or histopathology.
No benefit of granulocyte transfusions could be shown in the resolution of infection in patients with either invasive noncandidal infection (29% in the transfused patients vs. 23% in the nontransfused patients, p > 0.1) or candidal sepsis (56% vs. 50%, p > 0.1). Among patients with delayed marrow recovery, no difference was seen in the resolution of infection in the transfused (25.9%) and nontransfused (50%) patients (p > 0.1); nor was any difference between the transfused and nontransfused patients evident in the duration of febrile episode associated with the fungal infection. Granulocyte transfusions were well tolerated, with the only complications being fever in 12 patients (24%), chills in 10 (20%), and respiratory distress in 2 (4%). Despite attempts to stratify by infection type, invasiveness, and marrow recovery, it was not possible to show any benefit of granulocyte transfusions in this group.
It is likely that only through a prospective randomized trial can the question of the efficacy of granulocyte transfusions in treating fungal infections be conclusively answered.
进行了一项回顾性研究，以评估粒细胞输注对骨髓移植后中性粒细胞减少且伴有真菌感染患者的疗效。
在87例骨髓移植后的前100天内检测到系统性真菌感染；其中50例患者除接受适当的抗真菌药物治疗外，还接受了粒细胞输注。输注粒细胞的患者中位年龄为17岁（范围1.5 - 57岁），未输注粒细胞的患者中位年龄为35岁（范围0.8 - 50岁）。粒细胞输注频率为每日1次至每日2次。为评估患者的反应，根据感染类型（念珠菌感染[n = 38]与非念珠菌感染[n = 49]）和感染部位（仅真菌血症[n = 30]与侵袭性感染[n = 57]）对患者进行分类。感染的缓解定义为体征和症状消失，以及培养和/或组织病理学检查结果为阴性。
对于侵袭性非念珠菌感染患者（输注粒细胞的患者缓解率为29%，未输注粒细胞的患者缓解率为23%，p > 0.1）或念珠菌败血症患者（缓解率分别为56%和50%，p > 0.1），未显示粒细胞输注对感染缓解有任何益处。在骨髓恢复延迟的患者中，输注粒细胞的患者（25.9%）与未输注粒细胞的患者（50%）在感染缓解方面无差异（p > 0.1）；在与真菌感染相关的发热持续时间方面，输注粒细胞的患者与未输注粒细胞的患者之间也无明显差异。粒细胞输注耐受性良好，仅12例患者（24%）出现发热，10例（20%）出现寒战，2例（4%）出现呼吸窘迫。尽管试图根据感染类型、侵袭性和骨髓恢复情况进行分层分析，但仍未显示粒细胞输注对该组患者有任何益处。
很可能只有通过前瞻性随机试验才能最终回答粒细胞输注治疗真菌感染疗效的问题。
