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The Role of Therapeutic and Prophylactic Granulocyte Transfusions in Adult Acute Leukemia

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Adult Leukemias 1

Part of the book series: Cancer Treatment and Research ((CTAR,volume 5))

Abstract

Great strides have been made in the induction phase of treatment for acute leukemia. Although the majority of patients will achieve an initial remission, varying periods of pancytopenia are experienced by virtually all patients as a consequence both of leukemic replacement of the bone marrow and of chemotherapy. Anemia is easily treated by transfusions because erythrocytes are accurately typed and circulate in the blood for weeks. Thrombocytopenia is more difficult to treat than anemia. Platelets exhibit a comparatively short survival in recipient blood, and many patients become refractory (unresponsive) due to donor-recipient incompatibility. Selecting donors from blood relatives with HLA-types similar to those of the recipient lessens incompatibility problems, but some patients remain refractory. However, the incidence of life-threatening hemorrhage has been markedly decreased by the use of prophylactic and therapeutic platelet transfusions [1]. The correction of leukopenia, notably granulocytopenia, by transfusion is particularly challenging, but granulocyte transfusions (GTX) have been clearly shown to add benefit to antibiotics in treating gram-negative sepsis in certain patients with prolonged neutropenia [2]. Uncertainty about GTX therapy exists because the circulating half-life of granulocytes in blood is extremely short (under some circumstances transfused cells cannot even be detected in recipient blood), and information is limited regarding donor-recipient granulocyte matching. Despite these putative problems, GTX have been employed to prevent and to treat serious infections in animals [3–5] and man [reviewed in 2, 6–9]. Although GTX have been endorsed enthusiastically by many, cautionary voices raised earlier [10] have gained support [2, 11]. Concerns have been: a) the small numbers of patients studied in controlled trials; b) the relatively small numbers of granulocytes transfused (1010 infused per day when endogenous production during infection may approximate 1012); c) the satisfactory, but imperfect function of neu-trophils prepared for transfusion, particularly if not infused immediately [12] ; d) the suspected risks of alloimmunization such as transfusion reactions, impaired granulocyte function, platelet refractoriness, and rendering patients poor candidates for bone marrow transplantation; e) the expense in blood resources and money (although based largely on estimates, therapeutic and prophylactic GTC were calculated to cost, respectively, $ 17.7 and $ 57.8 million nationwide in 1978 [13]); and f) the inconveniences and potential risks to which donors are exposed [14].

Supported in part by contracts N01-HB6-2973 and N01-HB6-2972 from the National Heart, Lung and Blood Institute, NIH. Dr. Strauss is recipient of Research Career Development Award K04-HD00255 from the National Institute of Child Health and Human Development.

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Authors
  1. Ronald G. Strauss
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  2. John E. Connett
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Editors and Affiliations

  1. University of Minnesota, Minneapolis, USA

    Clara D. Bloomfield

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© 1982 Martinus Nijhoff Publishers bv, The Hague

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Strauss, R.G., Connett, J.E. (1982). The Role of Therapeutic and Prophylactic Granulocyte Transfusions in Adult Acute Leukemia. In: Bloomfield, C.D. (eds) Adult Leukemias 1. Cancer Treatment and Research, vol 5. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-7433-3_11

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  • DOI: https://doi.org/10.1007/978-94-009-7433-3_11

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