Annals of Hematology

, Volume 97, Issue 11, pp 2061–2070 | Cite as

Clinical outcome of granulocyte transfusion therapy for the treatment of refractory infection in neutropenic patients with hematological diseases

  • Biqi Zhou
  • Tiemei Song
  • Yufeng Feng
  • Ziling Zhu
  • Weirong Chang
  • Yuejun Liu
  • Aining Sun
  • Depei WuEmail author
  • Yang XuEmail author
Original Article


Neutropenic patients with hematological diseases are prone to severe infections. Granulocyte transfusion therapy (GTX) is considered as a logical therapeutic approach for these problems. However, the efficacy and complications of GTX have not been well identified. We retrospectively analyzed the clinical outcomes of GTX therapy in our hospital from 2009 to 2015. After 117 granulocyte transfusions for 47 patients, 72.3% of these patients’ infections were effectively improved, and the overall survival rates at 30 and 120 days were 66.0 and 57.5%, respectively. The patients who experienced neutrophil recovery within 10 days after their therapy initiation had a better response and long-term survival period (14/15, 93.3%, vs 20/32, 62.5%, P = 0.037). Higher-dose granulocytes (> 2.55 × 108/kg) might improve the effective rate of infection in the patients who had more than 10 days neutrophil recovery time (17/23, 73.9%, vs 3/9, 33.3%, P = 0.049). In addition, GTX benefited the patients who suffered from pulmonary bacterial infections (16/20, 80%) compared with the bloodstream infection group (7/12, 58.3%) and skin or mucous infection group (1/5, 20%). The primary data showed that GTX did not affect the incidence of graft-versus-host disease (GVHD) and cytomegalovirus viremia when patients received further HSCT treatment. Collectively, GTX was an adjunct treatment modality for severely neutropenic patients who were likely to experience hematopoietic recovery. More randomized trials are needed to verify the efficacy and complications of GTX therapy.


Granulocyte transfusion therapy Neutropenia Refractory infection Hematopoietic stem cell transplantation 


Funding information

This work was supported in part by grants from the Natural Science Foundation of Jiangsu Province (BK20171205), the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), the National Natural Science Foundation of China (81302046, 81730003), Innovation Capability Development Project of Jiangsu Province (BM2015004), and the National Key R&D Program of China (2016YFC0902800, 2017YFA0104502).

Compliance with ethical standards

This study was conducted in compliance with the institutional policy regarding the protection of patients’ private information and approved by the Research Ethics Committee of the First Affiliated Hospital of Soochow University. All the methods were carried out in accordance with the approval guidelines of The First Affiliated Hospital of Soochow University.

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Strauss RG (1993) Therapeutic granulocyte transfusions in 1993. Blood 81:1675–1678PubMedGoogle Scholar
  2. 2.
    Price TH, Boeckh M, Harrison RW, McCullough J, Ness PM, Strauss RG, Nichols WG, Hamza TH, Cushing MM, King KE, Young JAH, Williams E, McFarland J, Holter Chakrabarty J, Sloan SR, Friedman D, Parekh S, Sachais BS, Kiss JE, Assmann SF (2015) Efficacy of transfusion with granulocytes from G-CSF/dexamethasone–treated donors in neutropenic patients with infection. Blood 126:2153–2161CrossRefGoogle Scholar
  3. 3.
    Strauss RG (1999) Rebirth of granulocyte transfusions: should it involve pediatric oncology and transplant patients? J Pediatr Hematol Oncol 21:475–478CrossRefGoogle Scholar
  4. 4.
    Sachs UJ, Reiter A, Walter T, Bein G, Woessmann W (2006) Safety and efficacy of theraputic early onset granulocyte transfusions in pediatric patients with neutropenia and severe infections. Transfusion 46:1909–1914CrossRefGoogle Scholar
  5. 5.
    Cugno C, Deola S, Filippini P, Stroncek DF, Rutella S (2015) Granulocyte transfusions in children and adults with hematological malignancies: benefits and controversies. J Transl Med 13:362CrossRefGoogle Scholar
  6. 6.
    Seidel MG, Minkov M, Witt V, Matthes-Martin S, Pötschger U, Worel N, Leitner G, Stary J, Gadner H, Peters C (2009) Granulocyte transfusions in children and young adults: does the dose matter? J Pediatr Hematol Oncol 31:166–172CrossRefGoogle Scholar
  7. 7.
    Weingarten C, Pliez S, Tschiedel E et al (2016) Granulocyte transfusions in critically ill children with prolonged neutropenia: side effects and survival rates from a single-center analysis. Eur J Pediatr 175:1–9CrossRefGoogle Scholar
  8. 8.
    Vamvakas EC, Pineda AA (1997) Determinants of the efficacy of prophylactic granulocyte transfusions: a meta-analysis. J Clin Apher 12:74–81CrossRefGoogle Scholar
  9. 9.
    Dignani MC, Anaissie EJ, Hester JP, O’Brien S, Vartivarian SE, Rex JH, Kantarjian H, Jendiroba DB, Lichtiger B, Andersson BS, Freireich EJ (1997) Treatment of neutropenia-related fungal infections with granulocyte colony-stimulating factor-elicited white blood cell transfusions: a pilot study. Leukemia 11:1621–1630CrossRefGoogle Scholar
  10. 10.
    Averbuch D, Engelhard D, Pegoraro A, Cesaro S (2016) Review on efficacy and complications of granulocyte transfusions in neutropenic patients. Curr Drug Targets 17:1–1CrossRefGoogle Scholar
  11. 11.
    Mousset S, Stella H, Stefan AK et al (2005) Prophylactic and interventional granulocyte transfusions in patients with haematological malignancies and life-threatening infections during neutropenia. Ann Hematol 84:734–741CrossRefGoogle Scholar
  12. 12.
    Peters C, Minkov M, Matthes-Martin S, Potschger U, Witt V, Mann G, Hocker P, Worel N, Stary J, Klingebiel T, Gadner H (1999) Leucocyte transfusions from rhG-CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients. Br J Haematol 106:689–696CrossRefGoogle Scholar
  13. 13.
    Seidel MG, Peters C, Wacker A, Northoff H, Moog R, Boehme A, Silling G, Grimminger W, Einsele H (2008) Randomized phase III study of granulocyte transfusions in neutropenic patients. Bone Marrow Transplant 42:679–684CrossRefGoogle Scholar
  14. 14.
    Cherif H, Axdorph U, Kalin M, Björkholm M (2013) Clinical experience of granulocyte transfusion in the management of neutropenic patients with haematological malignancies and severe infection. Scand J Infect Dis 45:112–116CrossRefGoogle Scholar
  15. 15.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, de Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377CrossRefGoogle Scholar
  16. 16.
    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJA, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49:1–45CrossRefGoogle Scholar
  17. 17.
    Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O'Grady NP, Bartlett JG, Carratalà J, el Solh AA, Ewig S, Fey PD, File TM Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL (2016) Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 63:575–582CrossRefGoogle Scholar
  18. 18.
    Hübel K, Carter RA, Liles WC et al (2002) Granulocyte transfusion therapy for infections in candidates and recipients of HPC transplantation: a comparative analysis of feasibility and outcome for community donors versus related donors. Transfusion 42:1414–1421CrossRefGoogle Scholar
  19. 19.
    O'Donghaile D, Childs RW, Leitman SF (2012) Blood consult: granulocyte transfusions to treat invasive aspergillosis in a patient with severe aplastic anemia awaiting mismatched hematopoietic progenitor cell transplantation. Blood 119:1353–1355CrossRefGoogle Scholar
  20. 20.
    Wang H, Wu Y, Fu R, Qu W, Ruan E, Wang G, Liu H, Song J, Xing L, Guan J, Li L, Liu C, Shao Z (2014) Granulocyte transfusion combined with granulocyte colony stimulating factor in severe infection patients with severe aplastic anemia: a single center experience from China. PLoS One 9:e88148CrossRefGoogle Scholar
  21. 21.
    Mannoni P, Rodet M, Vernant JP, Brun B, Coquin-Radeau EI, Bracq C, Rochant H, Dreyfus B (1979) Efficiency of prophylactic granulocyte transfusions in preventing infections in acute leukaemia. Rev Fr Transfus Immunohematol 22:503–518PubMedGoogle Scholar
  22. 22.
    Gomez-Villagran JL, Torres-Gomez A, Gomez-Garcia P, Martinez-Guibelalde F, Velasco-Jimena F (1984) A controlled trial of prophylactic granulocyte transfusions during induction chemotherapy for acute nonlymphoblastic leukemia. Cancer 54:734–738CrossRefGoogle Scholar
  23. 23.
    Clift RA, Sanders JE, Thomas ED, Williams B, Buckner CD (1978) Granulocyte transfusions for the prevention of infection in patients receiving bone-marrow transplants. N Engl J Med 298:1052–1057CrossRefGoogle Scholar
  24. 24.
    Shaz BH, Stowell SR, Hillyer CD (2011) Transfusion-related acute lung injury: from bedside to bench and back. Blood 117:1463–1471CrossRefGoogle Scholar
  25. 25.
    Lee SE, Cho BS, Kim JH, Yoon JH, Shin SH, Yahng SA, Eom KS, Kim YJ, Kim HJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS, Park CW (2013) Risk and prognostic factors for acute GVHD based on NIH consensus criteria. Bone Marrow Transplant 48:587–592CrossRefGoogle Scholar
  26. 26.
    Flowers MED, Parker PM, Johnston LJ, Matos AV, Storer B, Bensinger WI, Storb R, Appelbaum FR, Forman SJ, Blume KG, Martin PJ (2002) Comparison of chronic graft-versus-host disease after transplantation of peripheral blood stem cells versus bone marrow in allogeneic recipients: long-term follow-up of a randomized trial. Blood 100:415–419CrossRefGoogle Scholar
  27. 27.
    Zecca M, Prete A, Rondelli R, Lanino E, Balduzzi A, Messina C, Fagioli F, Porta F, Favre C, Pession A, Locatelli F, AIEOP-BMT Group. Italian Association for Pediatric Hematology and Oncology-Bone Marrow Transplant (2002) Chronic graft-versus-host disease in children: incidence, risk factors, and impact on outcome. Blood 100:1192–1200CrossRefGoogle Scholar
  28. 28.
    Anasetti C, Logan BR, Lee SJ, Waller EK, Weisdorf DJ, Wingard JR, Cutler CS, Westervelt P, Woolfrey A, Couban S, Ehninger G, Johnston L, Maziarz RT, Pulsipher MA, Porter DL, Mineishi S, McCarty J, Khan SP, Anderlini P, Bensinger WI, Leitman SF, Rowley SD, Bredeson C, Carter SL, Horowitz MM, Confer DL, Blood and Marrow Transplant Clinical Trials Network (2012) Peripheral-blood stem cells versus bone marrow from unrelated donors. N Engl J Med 367:1487–1496CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Biqi Zhou
    • 1
    • 2
  • Tiemei Song
    • 1
  • Yufeng Feng
    • 1
  • Ziling Zhu
    • 1
  • Weirong Chang
    • 1
  • Yuejun Liu
    • 1
    • 3
  • Aining Sun
    • 1
    • 2
    • 3
  • Depei Wu
    • 1
    • 2
    • 3
    Email author
  • Yang Xu
    • 1
    • 2
    • 3
    Email author
  1. 1.Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Healththe First Affiliated Hospital of Soochow UniversitySuzhouPeople’s Republic of China
  2. 2.Institute of Blood and Marrow TransplantationSoochow UniversitySuzhouPeople’s Republic of China
  3. 3.Collaborative Innovation Center of HematologySoochow UniversitySuzhouPeople’s Republic of China

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