Oza, A., Hallemeier, C., Goodnough, L., Khoury, H., Shenoy, S., Devine, S., . . . Adkins, D. (2006). Granulocyte-colony-stimulating factor-mobilized prophylactic granulocyte transfusions given after allogeneic peripheral blood progenitor cell transplantation result in a modest reduction of febrile days and intravenous antibiotic usage. Transfusion, 46, 14–23.

To compare the clinical outcomes between allogeneic peripheral blood stem cell (PBSC) recipients who did and did not receive matched granulocyte transfusions.

Patients who did not have an ABO matched donor were assigned to a comparison control group, and those with a matched donor were assigned to receive granulocyte transfusions.  Patients received conditioning either with total body irradiation, etoposide and cyclophosphamide or busulfan and cyclophosphamide given over seven days, or the regimen of total body irradiation and cyclophosphamide administered over three days.  Posttransplant granulocyte colony-stimulating factor was given to all patients on day 1 until neutrophil recovery.  No prophylactic antibacterial or antifungal antibiotics were given.  Prophylactic acyclovir was given to prevent herpes simplex infection.  Empiric antibiotic therapy was given for an initial fever of 38.3°C or higher.  Empiric therapy of amphotericin B was given for persistent fever.

• One hundred fifty-one donor-recipient pairs were included.
• Mean age was 44.5 years (range 14–68).
• Of the patients included, 56.3% were male and 43.7% were female.
• The majority of patients had leukemia, myelodysplastic syndrome, myelofibrosis, or aplastic anemia.

• Single site  
• Inpatient  
• United States

Patients were undergoing the active antitumor treatment phase of care. 

This was a prospective two-group study.

• Onset of neutropenia (defined as absolute neutrophil count [ANC] decrease to 500/mm³)
• Recovery (defined as the first day after ANC nadir that ANC increased to 500/mm³ for three consecutive days)
• A febrile day (defined as any day during hospitalization with a temperature of 38.3°C or higher)
• Bacteremia included culture-proven systemic blood infections.

Patients receiving granulocyte transfusion had a mean of 13.2 days of hospitalization, compared to 29.6 days in the control group (p = 0.03).  Patients receiving transfusions had fewer days of severe neutropenia.  This difference was 1.5 days on average (p = 0.0005).  The percentage of patients who developed fever during hospital stay from the start of conditioning to discharge was 82.7% in patients who did not receive granulocytes versus 64.2% in those who received granulocyte transfusions (p = 0.03). There were no other differences between groups in bacteremia or overall survival.

Granulocyte transfusions in this group of patients may have a statistically significant but clinically mild beneficial effect on the duration of neutropenia and hospital stay.

• Risk of bias (no blinding and no random assignment)  
• Unintended interventions or applicable interventions not described that would influence results *

* There was no subgroup analysis between those who may have received empiric treatment for fever as described in the study methods; therefore, it is unclear if such treatment influenced the results.  Sample sizes with results reporting tend to vary throughout the report, so it is unclear if this is related to missing data from the retrospective method.

The findings suggested that granulocyte transfusions may have some benefits for allogeneic stem cell transplant recipients; however, this study did not provide strong support for this intervention due to study limitations.  Because these patients did not receive routine prophylactic antibiotic or antifungal treatment, it is not clear what the clinical role of granulocyte transfusion might be in the setting of more aggressive preventive clinical management.