Pham, H. P., Rogoza, K., Stotler, B., Duffy, D., Parker-Jones, S., Ginzburg, Y., . . . Schwartz, J. (2012). Granulocyte transfusion therapy in pediatric patients after hematopoietic stem cell transplantation: a 5-year single tertiary care center experience. Journal of Pediatric Hematology/Oncology, 34, e332–e336.

To determine the efficacy of granulocyte transfusion in neutropenic pediatric patients after undergoing hematopoietic stem cell transplantation (HSCT).

A retrospective observational review analysis was performed on all pediatric HSCT recipients between January 2005 and and January 2010 in a single center.

• Sixteen patients (56% male, 44% female) were included.
• Average patient age was 12 years.
• All patients met the criteria for granulocyte transfusion, including an absolute neutrophil count (ANC) less than 500 cells/mm³, documented bacteria land/or fungal infections, and reasonable hope for bone marrow recovery or engraftment.

• Single site
• Inpatient 
• Morgan Stanley Children’s Hospital of New York – Presbyterian – Columbia University Medical Center

• Patients were undergoing the active antitumor treatment phase of care. 
• The study has clinical applicability for pediatrics.

This was a retrospective observational review.

Data were analyzed using Fisher exact test for binary outcomes and the 2-tailed t test for continuous outcomes.

One hundred fifty-three granulocyte transfusions were administered to 16 pediatric HSCT recipients. Patients had bacterial infections (69%), fungal infections (19%), and combined infections (12%). Concurrent infections, mostly bacterial (60%), occurred. One adverse reaction of pulmonary toxicity was reported.  The ANC of the stimulated products was significantly higher compared with the unstimulated products; however, neither the average number of granulocytes transfused by weight nor the outcomes difference were noticed between groups.

Granulocyte transfusion is safe in neutropenic and infected pediatric patients after HSCT. There was no difference in the outcomes between the groups that received stimulated products and those that received unstimulated products.

• Small sample (<30)
• Risk of bias (no control group)
• Findings were not generalizable.
• Time effect:  New antibiotics, along with new dosing, develop constantly, and the clinical care/treatment may have been different across the time span (2005–2010) of the study.  The authors did not look at difference in the clearing of infections or the survival between the two groups.  No information was provided regarding the prevalence of alloimmunization nor the compatibility between patients and the granulocyte units.

Recruiting pediatric patients for a randomized, controlled trial continues to be challenging.