Mousset, S., Hermann, S., Klein, S. A., Bialleck, H., Duchscherer, M., Bomke, B., . . . Martin, H. (2005). Prophylactic and interventional granulocyte transfusions in patients with haematological malignancies and life-threatening infections during neutropenia. Annals of Hematology, 84, 734–741.

To describe one organization’s experience and findings with the use of prophylactic and interventional granulocyte infusions.

Two different approaches with granulocyte transfusions were used: (1) as an intervention for patients with progressive life-threatening infections and (2) to prevent the recurrence of infections in patients at high risk, including those undergoing allogeneic peripheral stem cell transplant. Patients receiving prophylactic treatment were scheduled for granulocyte transfusion from the beginning of neutropenia in the treatment cycle.  As an intervention, transfusions were given to patients with an absolute neutrophil count (ANC) less than 100/mm³ if they had a life-threatening infection despite other prophylactic antimicrobial treatment or severe infections during a previous neturopenic period, with a high risk of recurrence.  Timing and frequency of granulocyte transfusions were not described, but it was stated that transfusions were stopped if the ANC was greater than 500/mm³ 48 hours after the last transfusion.  Outcomes were evaluated 30 days after the first transfusion.

• Sixty-seven patients (79% male, 21% female) were included. 
• Median age was 56 years in the prophylactic group and 52 years in the interventional group (range 21–68).
• All patients had leukemia or non-Hodgkin lymphoma; 42% were undergoing transplant, 27% were receiving consolidation chemotherapy, and 24% were receiving salvage chemotherapy. Seventy-six percent of patients had a previous underlying fungal infection.

• Single site  
• Inpatient  
• Germany

Patients were undergoing the active antitumor treatment phase of care.

 This was a descriptive observational study.

European Organization for Research and Treatment of Cancer (EORTC) criteria for the classification of fungal infections

• Twelve percent of patients died with an inability to control infection.  
• In 82% of the treatment cycles, there was a positive response, and benefit seemed to be greater in the case of fungal infections, with prophylactic use (p = 0.01).
• Transfusions were reported to be well tolerated.

This study described the use of granulocyte transfusions and findings between prophylactic and interventional use related to fungal infections.

• Small sample (<100)
• Risk of bias (no control group, no blinding, no random assignment) 
• Unintended interventions or applicable interventions that would influence results were not described.*
• Selective outcomes reporting*
• Measurement/methods were not well described.

* Results reporting provides individual case details but little analysis of results and only analysis of difference between prophylactic use and interventional use in a small subset of patients who developed fungal infections.  There was no information regarding antifungal prophylaxis or other aspects of care that can be expected to affect these outcomes.  Reporting of percentages varied between the sample percent, cycles, or episodes of transfusion.  Many of the cases reported as fungal infection were actually possible rather than actual according to the EORTC criteria used. There was no subgroup analysis between various sample groups with different infection risks.

This study provided minimal information; it described an experience in using granulocyte transfusions.