Korean J Med.  2003 Apr;64(4):459-467.

Granulocyte transfusions from G-CSF- and dexamethasone-stimulated healthy donors for treatment of patients with severe neutropenia-related infections

• Lee BH
• Lee JJ
• Kim YK
• Cho SH
• Shin DH
• Cho D
• Ryang DW
• Park MR
• Chung IJ
• Kim HJ

Abstract

BACKGROUND: Granulocyte transfusions have been used to treat severe, progressive infections in neutropenic patients who fail to respond to antimicrobial agents. Although corticosteroid or granulocyte colony-stimulating factor (G-CSF) were previously used separately to increase leukocyte counts in healthy donors, increasingly G-CSF and corticosteroids are used together, requiring the need to establish the efficacy of this mobilizing regime.
METHODS
This prospective study evaluated the safety and efficacy of granulocyte transfusion therapy from donors stimulated with a combination of G-CSF and dexamethasone, in 27 patients with severe neutropenia-related infections. To mobilize granulocytes, healthy volunteer donors received G-CSF, 5 micro gram/kg subcutaneously 12-14 hr before leukapheresis, and dexamethasone, 3 mg/m2 intravenously 15 min before leukapheresis.
RESULTS
Donor neutrophil counts were 5,723/micro L (range: 1,500~36,420) at baseline, 22,104/micro L (range: 9,700~41,300) before the injection of dexamethasone, 23,946/micro L (range: 10,900~42,100) immediately before leukapheresis, and 19,913/micro L (range: 9,100~36,300) after leukapheresis. Ninety-two leukapheresis procedures were performed with a mean yield of 7.88 10(10) granulocytes (range: 2.2~17.9 10(10)). The mobilizing agents were well tolerated in the donors. Of the patients, 16 (59.3%) showed favorable responses, whereas 11 (40.7%) had unfavorable responses. Adverse reactions to the therapy were arrhythmia in two patients (7.4%) and pulmonary edema in one patient (3.7%). Favorable responses were seen in 83.3, 76.9, and 45.5% of the patients from whom fungal, Gram-negative, and Gram-positive organisms were isolated, respectively.
CONCLUSION
This study suggests that the combination of G-CSF and dexamethasone is an effective, well-tolerated regimen for mobilizing granulocytes from healthy donors, and that granulocyte transfusion therapy is useful for neutropenic patients, especially those with fungal or Gram-negative infections that are resistant to appropriate antimicrobial agents.

Keyword

Leukocyte transfusion; Neutropenia; Infection; Granulocyte-colony stimulating factor; Dexamethasone

MeSH Terms

Adrenal Cortex Hormones
Anti-Infective Agents
Arrhythmias, Cardiac
Dexamethasone
Granulocyte Colony-Stimulating Factor
Granulocytes*
Healthy Volunteers
Humans
Leukapheresis
Leukocyte Count
Leukocyte Transfusion
Neutropenia
Neutrophils
Prospective Studies
Pulmonary Edema
Tissue Donors*
Adrenal Cortex Hormones
Anti-Infective Agents
Dexamethasone
Granulocyte Colony-Stimulating Factor