Granulocyte Transfusion in Pediatric and Adult Neutropenic Patients: A 16-Year Retrospective Review

TL;DR

This study reviews 16 years of granulocyte transfusions in neutropenic patients and finds higher doses may improve survival, but more research is needed.

Contribution

The study provides a long-term, single-institution analysis of granulocyte transfusion outcomes and explores the impact of HLA antibodies on ANC increments.

Findings

Higher body weight, more transfusions, and greater granulocyte dose per kilogram were associated with improved survival.

HLA-cPRA Class I and II IgG antibodies correlated with lower ANC increments.

High-dose transfusions showed a trend toward better outcomes, but results were not statistically significant.

Abstract

Background

Granulocyte transfusion therapy has been explored as a potential treatment for severe neutropenia, particularly in patients with life-threatening infections unresponsive to conventional therapies. However, its clinical utility remains uncertain due to inconsistent evidence, challenges in donor availability, and risks of alloimmunization. Here, we evaluated granulocyte transfusions administered to 35 pediatric and adult patients at our institution.

Materials and methods

A retrospective chart review was conducted for 35 patients who received granulocyte transfusions between 2009 and 2024. Patient data included demographics, primary diagnosis, infection type, infection site, average granulocyte count in the units, average granulocyte dose, human leukocyte antigen-calculated panel reactive antibody (HLA-cPRA) Class I and II IgG antibodies, 42- and 90-day survival, average post-transfusion absolute neutrophil count (ANC) increment, and number of transfusions. Binomial logistic regression analysis was performed to determine the clinical variables associated with increased survival.

Results

Overall survival at 42 and 90 days was 21/35 (60%) and 20/35 (57%), respectively. No significant survival differences were observed based on infection type, diagnosis, or sex. Higher body weight, increased number of transfusions, and greater granulocyte dose per kilogram were associated with improved survival. While high-dose transfusions (≥0.6×109/kg) showed a trend toward better outcomes, statistical significance was not reached. HLA-cPRA Class I and II IgG antibodies correlated with lower ANC increments, though sample size limited definitive conclusions.

Conclusion

Granulocyte transfusions may benefit patients with severe neutropenia, particularly with higher doses. There are limited studies in the literature investigating the impact of HLA antibodies on ANC increment. In this study, we aimed to address this knowledge gap by providing our 16-year data from a single institution. Further prospective studies are needed to refine dosing strategies, assess the role of human leukocyte antigen alloimmunization, and optimize patient selection for improved clinical outcomes.

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