PB2362 GRANULOCYTE TRANSFUSIONS IN SEVERELY NEUTROPENIC CHILDREN: A SINGLE CENTRE EXPERIENCE
Authors: Sen S. , Mullanfiroze K. , Tulpule S. , Gupta S. , Singhal T. 
Published: June 2019

Background:

Severe neutropenia occurs in majority of children undergoing intensive chemotherapy and during hematopoietic stem cell transplant(HSCT). During these episodes, bacterial and fungal infections are frequently observed. Recently, there has been an increase in the incidence of multi‐drug resistant(MDR) bacterial infections. Antibiotics alone, may not be enough in combatting these MDR organisms and thus there was a felt need for using granulocyte infusions, at least until marrow recovery. Despite numerous clinical trials, efficacy of granulocyte transfusions yet remains controversial. However, we hereby collate a tertiary pediatric centre's experience on the use of granulocytes.

Aims:

To determine whether early Granulocyte transfusions makes a difference in outcomes of septic neutropenic children

Methods:

A retrospective analysis on all those children in the pediatric oncology or HSCT unit who received granulocyte infusions from November 2017‐July 2018 was conducted for this study. Collated data included age, sex, hospital number, primary diagnosis, indication for granulocyte infusion, blood culture and/or histopathology results, number of granulocyte infusions, dose of granulocytes infused and outcome. Granulocyte transfusion was considered in the setting of a documented GNB in blood culture or a definite invasive fungal infection(IFI) and severe neutropenia. A universal protocol of performing hemapheresis on a voluntary granulocyte donor 6‐8 hours after administering 8 mg oral dexamethasone along with subcutaneous GCSF (10mcg/kg, to a maximum of 600 mcg) was used.

Results:

Total of six episodes of gram negative bacilli(GNB) bacteremia and one episode of definite IFI in children with severe neutropenia were treated with granulocyte infusions and other supportive care measures from November 2017‐July 2018. Five boys and one girl with a median age of 8 years (range 7‐13 years) underwent 30 granulocyte infusions from 17 voluntary donors. The commonest primary diagnosis in this cohort was acute leukemia(3 = ALL,2 = AML,1 = very severe aplastic anemia). Notably, in all but one, GNB blood cultures were carbapenem resistant. Median dose of granulocytes infused was 1 × 1010/infusion(range 0.6‐1.65 × 1010). In four of these episodes, granulocytes were initiated before hemodynamic compromise(defined as transfer of the child to the pediatric intensive care unit and/or initiating ionotropic support and/or need for mechanical ventilation). Outcome of three of these four(75%) children was favourable i.e. the infection was controlled and these children survived the crisis. Of the entire cohort, three of the seven infection episodes(42%) had a favourable outcome.

Summary/Conclusion:

Granulocyte transfusions before hemodynamic compromise in cases of severe neutropenia after myelosuppressive chemotherapy or while awaiting engraftment following HSCT, in the setting of proven MDR‐GNB bacteremia or disseminated fungal infections is safe and can be considered as a life‐saving measure, in reducing morbidity and mortality.