Blood, Vol. 95 No. 11 (June 1), 2000:
pp. 3605-3612
Effect of leukocyte compatibility on neutrophil increment after
transfusion of granulocyte colony-stimulating factor-mobilized
prophylactic granulocyte transfusions and on clinical outcomes after
stem cell transplantation
Douglas R. Adkins,
Lawrence T. Goodnough,
Shalini Shenoy,
Randy Brown,
Jennifer Moellering,
Hanna Khoury,
Ravi Vij, and
John DiPersio
From the Department of Internal Medicine, Division of Bone Marrow
Transplantation and Stem Cell Biology; the Department of Pathology,
Division of Laboratory Medicine; and the Department of Pediatrics,
Division of Hematology/Oncology, Washington University School of
Medicine, St Louis, MO.
The primary limitations of granulocyte transfusions
include low component cell dose and leukocyte incompatibility.
Component cell dose improved with granulocyte colony-stimulating factor (G-CSF) mobilization, and the transfusion of
G-CSF-mobilized, human leukocyte antigen (HLA)-matched
granulocyte components resulted in significant, sustained absolute
neutrophil count (ANC) increments. However, the effect of leukocyte
compatibility on outcomes with G-CSF-mobilized granulocyte
transfusions is unclear. The objectives were to determine the effect of
leukocyte compatibility on ANC increments and selected clinical
outcomes after transfusion of prophylactic, G-CSF-mobilized
granulocyte components into neutropenic recipients of autologous
peripheral blood stem cell (PBSC) transplants. Beginning on transplant
day 2, 23 evaluable recipients were scheduled to receive 4 alternate-day transfusions of granulocyte components apheresed from a
single donor given G-CSF. G-CSF was also given to recipients after
transplantation. Recipient ANC was determined before and sequentially
after each granulocyte transfusion to determine the peak ANC increment.
Leukocyte compatibility was determined at study entry only by a
lymphocytotoxicity screening assay (s-LCA) against a panel of
HLA-defined cells. Eight recipients had positive s-LCA. On
days 2 and 4, the mean peak ANC increments after granulocyte
transfusion were comparable between the cohorts with positive and
negative s-LCA. However, the mean peak ANC increments on day 6 (246/µL vs 724/µL; P = .05) and day 8 (283/µL vs
1079/µL; P = .06) were lower in the cohort with positive
s-LCA, in spite of the transfusion of comparable component cell doses.
Adverse reactions occurred with only 5 of 87 (5.7%) granulocyte
transfusions and were not associated with leukocyte compatibility test
results. Platelet increments, determined 1 hour after granulocyte
transfusion, were comparable between the cohorts. Although the 2 cohorts received PBSC components with similar CD34+ cell
doses, the cohort with a positive s-LCA had delayed neutrophil engraftment and a greater number of febrile days and required more days
of intravenous antibiotics and platelet transfusions. Leukocyte
incompatibility adversely affected ANC increments after the transfusion
of G-CSF-mobilized granulocyte components and clinical outcomes after
PBSC transplantation.
