Granulocyte transfusion therapy

Abstract

Granulocyte transfusion therapy is often used in patients with severe neutropenia after chemotherapy who develop bacterial and fungal infections not responsive to antimicrobial therapy. Granulocyte products may be obtained by a leukapheresis procedure or by pooling buffy coat layers from whole blood. Donors must be stimulated with dexamethasone with or without granulocyte-colony stimulating factor to enhance granulocyte collection yields. The dose of granulocytes transfused is key to observing any positive effects. Higher doses are more likely to lead to detectable clinical efficacy. However, several challenges exist for obtaining sufficient granulocytes in each product. Among them are the ability to stimulate donors adequately and the efficiency of the collection instruments used. To this day, there has been no definitive evidence to show the clinical efficacy of granulocyte transfusion therapy. Published studies have shown a wide range of results from inconclusive to no benefit or benefit over not using granulocyte products. A well-designed and adequately powered randomized-controlled clinical trial would provide the needed evidence to determine whether granulocyte transfusion therapy is truly beneficial. The hurdles to conducting such a clinical trial are demonstrated by the Resolving Infection in Neutropenia and Granulocyte (RING) trial and may never be overcome. More creative ways of obtaining sufficient data need to be employed.