背景:对于长期中性粒细胞减少和严重感染的患者,进行粒细胞输注一直是一个有争议的做法。先前的研究表明高剂量粒细胞输血(≥0.6×109/kg)的益处,虽然,直到最近,高剂量单位的一致生产一直具有挑战性。这里,我们展示了我们利用大剂量粒细胞输血的经验和结果,三级学术医学中心,用于治疗成人感染,中性粒细胞减少症患者。
方法:对接受粒细胞集落刺激因子(G-CSF)和地塞米松刺激的供体大剂量粒细胞输血的所有患者进行回顾性图表回顾(2018-2021年)。收集的参数包括患者人口统计,临床病史,感染状态,剂量,临床结果,中性粒细胞绝对计数(ANC)前后,和输血时间,包括粒细胞收集之间的时间,administration,和输血后ANC计数。收集的参数使用描述性统计进行汇总,采用Kaplan-Meier曲线/对数秩/回归检验评估结局.
结果:总共28名成人,抗微生物剂和/或G-CSF难以治疗的中性粒细胞减少患者总共接受了173种粒细胞浓缩物.中位ANC从输血前的0.7×109/L增加到输血后的1.6×109/L。平均粒细胞产量为77.4×109,每公斤平均剂量为0.90×109±0.30×109粒细胞。第42天的复合生存率和微生物反应为42.9%(n=12/28),无明显不良反应。
结论:这里,我们证明了对中性粒细胞减少患者进行大剂量粒细胞输血是成功和安全的.鉴于快速和一致的生产,分布,提高了粒细胞质量,现在有可能进一步研究以确定G-CSF引发的粒细胞输注的临床疗效.
BACKGROUND: Granulocyte transfusions for patients with prolonged neutropenia and severe infections has been a controversial practice. Previous studies suggest a benefit of high-dose granulocyte transfusions (≥0.6 × 109/kg), although, until recently, the consistent production of high-dose units has been challenging. Here, we present our experience and results utilizing high-dose granulocyte transfusions at a large, tertiary academic medical center for the treatment of infections in adult, neutropenic patients.
METHODS: A retrospective chart review (2018-2021) was conducted for all patients who received high-dose granulocyte transfusions from donors stimulated with granulocyte colony-stimulating factor (G-CSF) and dexamethasone. Gathered parameters included patient demographics, clinical history, infection status, dose, clinical outcomes, pre- and post-absolute neutrophil count (ANC), and transfusion times including time between granulocyte collection, administration, and posttransfusion ANC count. Gathered parameters were summarized using descriptive statistics, outcomes were assessed utilizing Kaplan-Meier curves/log-rank/regression testing.
RESULTS: Totally 28 adult, neutropenic patients refractory to antimicrobial agents and/or G-CSF received a total of 173 granulocyte concentrates. Median ANC increased from 0.7 × 109/L pre-transfusion to 1.6 × 109/L posttransfusion. The mean granulocyte yield was 77.4 × 109 resulting in an average dose per kilogram of 0.90 × 109 ± 0.30 × 109 granulocytes. Composite day 42 survival and microbial response was 42.9% (n = 12/28) without significant adverse reactions.
CONCLUSIONS: Here, we demonstrate the successful and safe implementation of high-dose granulocyte transfusions for neutropenic patients. Given the rapid and consistent production, distribution, and improved granulocyte quality, further investigations to determine the clinical efficacy of G-CSF primed granulocyte transfusions is now possible.