Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Non-irradiated GCSF stimulated leukocyte transfusion for necrotizing fasciitis after allogeneic stem cell transplant: a case report and review of the literature

Bone Marrow Transplantation volume 55, pages 1000–1003 (2020)Cite this article

Subjects

Abstract

Severe neutropenia remains among the most common complications associated with hematological diseases and their treatment, especially in the early poststem cell transplantation. Managing life-threatening infections associated with prolonged and profound neutropenia thus remains an essential component for the optimal care of patients undergoing transplant. Several therapeutic interventions have been attempted either to limit the duration of neutropenia through granulocyte colony stimulating factors (GCSF), or to treat associated infections through the use of granulocyte transfusions. The efficacy and safety of granulocyte transfusions have been controversial, and the conflicting results reported by several trials can be explained by the significant variability related to patient selection, timing of initiation, and duration of transfusions, preparation methods among multiple others. We herein report a case of life-threatening necrotizing fasciitis post haploidentical stem cell transplant, responding to the combination of antibiotics and daily transfusions of non-irradiated GCSF stimulated leukocytes from healthy donors without surgical intervention. We also provide a concise review of the available literature regarding the use of this intervention, its efficacy and safety and comparison of irradiated with non-irradiated transfusions.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Gea-Banacloche J. Granulocyte transfusions: a concise review for practitioners. Cytotherapy. 2017;19:1256–69.

    Article  Google Scholar 

  2. Strumia MM. The effect of leukocytic cream injections in the treatment of the neutropenias. Am J Med Sci. 1934;187:527–44.

    Article  Google Scholar 

  3. Freireich L, Whang C, Bronson M. The function and fate of transfused leukocytes from donors with chronic myeloid leukaemia in leukopenic recipients. Ann N Y Acad Sci. 1964;113:1081–9.

    Article  CAS  Google Scholar 

  4. Freireich EJ. Leukocyte transfusion and the development of the continuous-flow blood cell separator. Transfus Med Rev. 2011;25:344–50.

    Article  Google Scholar 

  5. Bensinger WI, Price TH, Dale DC, Appelbaum FR, Clift R, Lilleby K, et al. The effects of daily recombinant human granulocyte colony-stimulating factor administration on normal granulocyte donors undergoing leukapheresis. Blood. 1993;81:1883–8.

    Article  CAS  Google Scholar 

  6. Lowenthal RM, Grossman L, Goldman JM, Storring RA, Buskard NA, Park DS, et al. Granulocyte transfusions in treatment of infections in patients with acute leukaemia and aplastic anaemia. Lancet 1975;1:353–8.

    Article  CAS  Google Scholar 

  7. Graw RG, Herzig G, Perry S, Henderson ES. Normal granulocyte transfusion therapy: treatment of septicemia due to gram-negative bacteria. N Engl J Med. 1972;287:367–71.

    Article  Google Scholar 

  8. Vogler WR, Winton EF. A controlled study of the efficacy of granulocyte transfusions in patients with neutropenia. Am J Med. 1977;63:548–55.

    Article  CAS  Google Scholar 

  9. Winston DJ, Ho WG, Gale RP. Therapeutic granulocyte transfusions for documented infections. A controlled trial in ninety-five infectious granulocytopenic episodes. Ann Intern Med. 1982;97:509–15.

    Article  CAS  Google Scholar 

  10. Wright DG, Robichaud KJ, Pizzo PA, Deisseroth AB. Lethal pulmonary reactions associated with the combined use of amphotericin B and leukocyte transfusions. N Engl J Med. 1981;304:1185–9.

    Article  CAS  Google Scholar 

  11. Stroncek DF, Yau YY, Oblitas J, Leitman SF. Administration of G–CSF plus dexamethasone produces greater granulocyte concentrate yields while causing no more donor toxicity than G–CSF alone. Transfusion. 2001;41:1037–44.

    Article  CAS  Google Scholar 

  12. Safdar A, Rodriguez G, Zuniga J, Al Akhrass F, Pande A. Use of healthy-donor granulocyte transfusions to treat infections in neutropenic patients with myeloid or lymphoid neoplasms: experience in 74 patients treated with 373 granulocyte transfusions. Acta Haematol. 2014;131:50–58.

    Article  Google Scholar 

  13. Rutella S, Pierelli L, Sica S, Serafini R, Chiusolo P, Paladini U, et al. Efficacy of granulocyte transfusions for neutropenia-related infections: retrospective analysis of predictive factors. Cytotherapy. 2003;5:19–30.

    Article  CAS  Google Scholar 

  14. Grigull L, Pulver N, Goudeva L, Sykora KW, Linderkamp C, Beilken A, et al. G-CSF mobilised granulocyte transfusions in 32 paediatric patients with neutropenic sepsis. Support Care Cancer. 2006;14:910–6.

    Article  Google Scholar 

  15. Guo M, Hu KX, Yu CL, Sun QY, Qiao JH, Wang DH, et al. Infusion of HLA-mismatched peripheral blood stem cells improves the outcome of chemotherapy for acute myeloid leukemia in elderly patients. Blood. 2011;117:936–41.

    Article  CAS  Google Scholar 

  16. Freireich EJ, Lichtiger B, Mattiuzzi G, Martinez F, Reddy V, Kyle Wathen J. A prospective, randomized, double-blind study, comparing unirradiated to irradiated white blood cell transfusions in acute leukemia patients. Leukemia. 2013;27:861–5.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the nursing staff for providing excellent care for our patients and the physicians in the Hematology and Oncology division, various departments at the American University of Beirut Medical Center and referring physicians from Lebanon and the Middle East region for their significant contributions and dedicated patient care.

Author information

Authors and Affiliations

  1. Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon

    Nour Moukalled, Jean EL-Cheikh & Ali Bazarbachi

  2. Pulmoanry and Critical Care Medicine, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon

    Imad Bou Akl

  3. Department of Internal Medicine, American University of Beirut, Beirut, Lebanon

    Ahmad Al Masri

  4. Infectious disease, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon

    Zeina Kanafani

Authors
  1. Nour Moukalled
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Imad Bou Akl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmad Al Masri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zeina Kanafani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean EL-Cheikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Bazarbachi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NM collected data, provided clinical care, wrote and revised the manuscript. AM provided clinical care, contributed to and commented on the manuscript. IB provided clinical care, critical care support, and commented on the manuscript. ZK provided clinical care and commented on the manuscript. JE-C collected and analyzed data, provided clinical care, commented on and revised the manuscript. AB designed transplant program, provided clinical care, contributed to manuscript writing and edited the manuscript. All authors approved submission of the manuscript for publication purposes.

Corresponding author

Correspondence to Ali Bazarbachi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moukalled, N., Bou Akl, I., Al Masri, A. et al. Non-irradiated GCSF stimulated leukocyte transfusion for necrotizing fasciitis after allogeneic stem cell transplant: a case report and review of the literature. Bone Marrow Transplant 55, 1000–1003 (2020). https://doi.org/10.1038/s41409-019-0743-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-019-0743-6

Search

Advanced search

Quick links