Efficacy and Safety of G-CSF Mobilized Granulocyte Transfusions in Four Neutropenic Children with Sepsis and Invasive Fungal Infection

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Abstract
Background: Bacterial and fungal infections are serious complications of cancer therapy. Especially during longstanding neutropenia, patients are at risk for life-threatening infections. The aim of this study was to assess the effect and safety of G-CSF mobilized granulocyte transfusions (GTX) in four neutropenic pediatric patients with sepsis. Patients and Methods: The patients were between 4.6–17.5 years old and their diagnoses included very severe aplastic anemia, non-Hodgkin's lymphoma (NHL) and acute myeloid leukemia. Before GTX, all patients had fever despite antibiotic and antimycotic therapy, neutropenia (absolute neutrophil count ANC < 500/μl), increasing C-reactive protein (CRP) values, hypotension requiring dopamine infusion and three patients needed supplemental oxygen. The granulocyte donors received G-CSF (Neupogen™, 5 μg/kg body weight) 12 h prior to granulocyte apheresis. Results: In total, 40 GTX were performed (range 2–28 per patient). The mean increase of the granulocyte count 1 h after GTX was 1,310/μl (range 200–2,950/μl). Within the period of GTX the CRP values decreased in all patients. During or 24 h after the last GTX, the hypotension resolved and supplemental oxygen was stopped. One GTX was discontinued because of oxygen desaturation. Conclusion: GTX were a safe therapeutic measure with beneficial effects on serious infections in neutropenic children.

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