Prophylaxis with Granulocyte Transfusions in AML: A Boon for Neutropenia or Chasing Rainbows?
Authors: Shewale Sundar Popat 
Published: December 2024

Introduction: Granulocyte transfusions have been used for many decades to treat or prevent life-threatening infections in neutropenic patients. Granulocytes for transfusion can be obtained by one of two means: by apheresis or as a ‘buffy coat’ component derived from whole blood donation.

Aim: To study the utility of prophylactic buffy coat derived granulocyte transfusion in the treatment of Acute myeloid leukemia (AML) induction.

Material and Methods: This ambispective study includes newly diagnosed AML patients aged &gt;18 years who have undergone intensive chemotherapy (3+7) and received prophylactic buffy coat-derived granulocyte transfusions from October 1, 2021, to October 31, 2023. The primary endpoints were to assess the incidence of ICU admission, ICU stay duration, hospital stay duration, and transfusion support requirement (PRBCs, RDP, SDP). Secondary outcomes were to note transfusion-related adverse events and the duration of antibiotic therapy, to evaluate mortality from infection after buffy coat administration and compared to historical controls.

Results: Forty-seven patients who received buffy coat-derived granulocyte transfusions (Group A: Cases) and 51 retrospective AML patients without buffy coat-derived granulocyte transfusions (Group B: Control) were included. The median age at diagnosis was 41 years (range 20-58) in Group A and 40 years (range 18-67) in Group B. ECOG performance status, Gender distribution, Blood groups types were comparable in both groups. There was a male preponderance (Group A: Male: 26 (55.3%), Female: 21 (44.7%)). The median hemoglobin, absolute neutrophil count, and platelet counts in Group A were 8.2 g/dL (range 5.5-14.8), 0.9 X 10⁹/L (range 0.04-14.2), and 24 X 10⁹/L (range 2-320), respectively, while in Group B they were 8.1 g/dL (range 6.3-14.8), 1.9 X 10⁹/L (range 0-64.4), and 25 X 10⁹/L (range 3-265), respectively, before starting induction therapy. Primary prophylaxis was done for 38 (80.9%) patients, while secondary prophylaxis was done for 9 (19.1%) patients. The median duration of buffy coat-derived granulocyte transfusions was 5 days (range 1-13), with a median of 30 transfusions per patient, each bag containing 50 ml buffy coat with a granulocyte dose of 1 X 10⁹/L. FNHTR, allergic reactions and pulmonary reaction undermined were noted in 14 (29.8%), 1 (2.1%) & 1 (2.1%) in Group A patients, respectively.

The median incidence of ICU admission was 6 (12.8%) in Group A, with a median ICU stay of 8 days (range 2-16). The incidence was similar in Group B, with 5 (9.8%) ICU admissions and a shorter median ICU stay of 4 days (range 2-6). Median hospitalization duration was similar: 25 days (range 13-58) in Group A and 24 days (range 13-50) in Group B. There was a decrease in transfusion requirements in Group A compared to Group B [Group A: PRBCs: 4 (range 0-16), RDPs: 12 (range 0-45), SDPs: 0 (range 0-7.5); Group B: PRBCs: 8 (range 2-23), RDPs: 18 (range 0-55), SDPs: 2 (range 0-7.5)]. Sepsis-related induction mortality was similar in both groups [Group A: 2 (4.2%), Group B: 2 (3.9%)]. Documented bacterial and fungal infections positives were marginally higher in Group B [Group A: 19 (40.4%), Group B: 23 (45.5%)].

Conclusion: Buffy coat-derived granulocyte transfusions in AML patients undergoing induction chemotherapy were associated with a lower number of PRBCs and platelet transfusions. There were no significant differences observed in ICU admission, stay duration or hospitalization. There were increased transfusion-related adverse reactions. Further prospective studies are warranted to validate these findings and optimize transfusion protocols, particularly for AML patients who have limited transfusion donor support.

Keywords: PRBC: Packed Red blood transfusions, AML: Acute Myeloid Leukemia, Granulocyte Transfusion, Buffy Coat derived Granulocyte transfusion, Induction Chemotherapy, Neutropenia, Transfusion