443. Multiple Granulocyte Transfusions for the treatment of severe opportunistic infections in cancer patients - 2004 - 2007
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Granulocyte transfusions (GTX) are still an important adjuvant treatment option in patients with opportunistic infections (OIs) and neutropenia post intense chemotherapy, stem cell transplant (SCT) or refractory cancer. Antimicrobial therapy alone is often sub-optimal in severely immunosuppressed hosts.
Methods: Safety and efficacy were evaluated in 368 GTX collected from G-CSF primed donors. Response was defined as “favorable” vs. “un-favorable” base on resolution or worsening of clinical symptoms.
Results: Thirty-six patients with age of 55 ± 15 years received 11 ± 5 GTX (per patient) during 12 ± 8 days. Thirty-three (92%) had leukemia [AML 61%; ALL 17%, CLL 11%] and in 29 (81%) cancer was relapse/refractory. 97% of patients received antineoplastic therapy (16 ± 130 days) and 25% had a SCT prior to GTX. Twenty-three (64%) received G-CSF and 13 (36%) received GM-CSF prior to GTX. Twenty-six (72%) had neutropenia before GTX for 20 ± 24 days. GTX was started after 9 ± 7 days of admission (total admission 33 ±16 days). Twenty-five (69%) of the patient had fever before GTX and in 18 fever resolved while receiving GTX. Eighteen (50%) were in ICU (12 ± 11 days) and APACHE II score was 15 ± 5. For type of infections and outcome see Table. GTX bag's absolute WBC count was 55665 ± 13380; Neutrophils [%] 79 ± 6 (range 70 - 90). In 17(47%) patients GTX was discontinued due to unavailable donor or being discharged. Sixteen (44%) of the patient in favorable group had an increase in ANC post-GTX vs.10 (28%) in unfavorable group P=0.127. Post GTX ANC was 608 ± 732 cells/µL in the favorable group vs. 393 ±1889 cells/µL in the unfavorable group P=0.360. Five (14%) had shortness of breath and GTX was discontinued.
Conclusion: GTX seems to be safe and still useful in the treatment of fungal and bacterial OIs in patient with hematological malignancies.
Type of Infections
Favorable 25 (69%)Unfavorable 11 (31%)Total 36 (100%)
Clinically Documented3 (8)1 (3)4 (11)
Microbiologically Documented22 (61)10 (28)32 (89)
Bacterial Pneumonia2 (6)2 (6)4 (11)
Bacterial BSI / soft-tissue3 (8)03 (8)
Possible Fungal Pneumonia9 (25)2 (6)11(31)
Probable Fungal Pneumonia2 (6)1 (3)3 (8)
Proven Pneumonia3 (8)3 (8)6 (17)
Proven Fungemia / cutaneous2 (6)2 (6)4 (11)
Viral Pneumonia1 (3)01 (3)
Saud Ahmed, MD1, Shamin Ejaz, MD2, Gilhen Rodriguez, MD, Amar Safdar, MD2 and  G. H. Rodriguez, None..
S. Ejaz, None..
S. Ahmed, None..
A. Safdar, None., (1)University of Texas, Houston / M.D. Anderson Center, Houston, TX, (2)MD Anderson Cancer Center, Houston, TX