How do we…consistently provide high-dose granulocyte products for transfusions in neutropenic patients?

Abstract

Background: The therapeutic use of granulocyte transfusions for the treatment of infections in immunocompromised patients has been a controversial practice. Randomized controlled trials suggest that benefit may be provided when a high-dose product, defined as providing a dose of at least 0.6 × 10⁹ /kg, is offered. Here we describe the collection process and granulocyte product yield over a four-year period at a donation center supplying a large, tertiary academic medical center.

Methods: A retrospective chart review was performed for apheresis granulocyte donations collected between 2018 and 2021 following implementation of combined G-CSF and dexamethasone donor stimulation at our institution. Data collected includes donor demographics, G-CSF administration timeline, pre-collection cell counts, product yields, donor adverse events, and post-transfusion ANC increments.

Results: A total of 269 granulocyte units were collected from 184 unique donors. The median neutrophil yield (ANC) following G-CSF implementation was 7.5 × 10¹⁰ /unit. The proportion of granulocyte products meeting or exceeding a yield of 4.0 × 10¹⁰ per unit was 96.5%. These products resulted in measurable median ANC increment of 550/μL in transfused adult patients (n = 166 transfusions).

Discussion: In order to properly assess the effectiveness of granulocyte transfusions in patients, it is necessary to ensure that the products being transfused contain an adequate granulocyte dose. This study demonstrates that the combination of G-CSF and dexamethasone donor stimulation, followed by apheresis granulocyte collection, is safe and can reliably yield a high-dose product. Consistent production of high-dose units allows for better assessment of patient outcomes by reducing dosage variability.

Keywords: G-CSF; apheresis; dexamethasone; granulocyte.