Pediatric blood & cancer · 2008
Leukocyte transfusions revisited: stem cell graft stimulation in graft failure.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Taskinen Mervi, Talvensaari Kimmo, Hovi Liisa, Vettenranta Kim, Saarinen-Pihkala Ulla M
Аннотация
BACKGROUND: The aim was to evaluate the role of leukocyte transfusions (LTX) in relation to graft function during prolonged neutropenia after stem cell transplantation (SCT).
PROCEDURE: In 1989-2005, 22 SCT patients have received LTX in our unit. In all patients severe infection with profound neutropenia (<0.2 x 10(9)/L) preceded LTX. 13/22 had multi-organ failure or thrombotic microangiopathy. Irradiated leukocytes from pooled random donor products at 1.0 x 10(10) leukocytes/m(2)/day for a minimum of 3 days were used. Myeloid recovery and clinical benefit were analyzed.
RESULTS: Engraftment defined as an absolute neutrophil count (ANC) of >0.5 x 10(9)/L on three consecutive days was observed in 15/22 (68%) patients at median of 6 (range 2-25) days after LTX, and sustained engraftment (ANC of >0.5 x 10(9)/L for 4 weeks) in 11/22 (50%) patients. Clinical benefit was observed in 6/22 (27%) patients with a prolonged antecedent neutropenia, who still demonstrated rapid sustained engraftment after LTX. Ongoing thrombotic microangiopathy was associated with persistent graft failure.
CONCLUSIONS: LTX from random donors was associated with a rapid recovery of myeloid function in severely ill SCT patients. We speculate that allostimulation by LTX may have a role.
PROCEDURE: In 1989-2005, 22 SCT patients have received LTX in our unit. In all patients severe infection with profound neutropenia (<0.2 x 10(9)/L) preceded LTX. 13/22 had multi-organ failure or thrombotic microangiopathy. Irradiated leukocytes from pooled random donor products at 1.0 x 10(10) leukocytes/m(2)/day for a minimum of 3 days were used. Myeloid recovery and clinical benefit were analyzed.
RESULTS: Engraftment defined as an absolute neutrophil count (ANC) of >0.5 x 10(9)/L on three consecutive days was observed in 15/22 (68%) patients at median of 6 (range 2-25) days after LTX, and sustained engraftment (ANC of >0.5 x 10(9)/L for 4 weeks) in 11/22 (50%) patients. Clinical benefit was observed in 6/22 (27%) patients with a prolonged antecedent neutropenia, who still demonstrated rapid sustained engraftment after LTX. Ongoing thrombotic microangiopathy was associated with persistent graft failure.
CONCLUSIONS: LTX from random donors was associated with a rapid recovery of myeloid function in severely ill SCT patients. We speculate that allostimulation by LTX may have a role.