Rebirth of granulocyte transfusions: should it involve pediatric oncology and transplant patients?

Several methodologic advances, particularly use of recombinant granulocyte colony stimulating factor to stimulate donors, have made it possible to collect extraordinarily large numbers of normal neutrophils for transfusion into neutropenic patients with life-threatening infections. Because larger doses of neutrophils can be transfused, renewed interest has arisen in the use of neutrophil (granulocyte) transfusions to treat adult oncology patients and progenitor cell transplant recipients, in whom neutropenia complicated by severe infections persists as a significant problem, despite combination antibiotic therapy, recombinant cytokines, myeloid growth factors, and use of mobilized peripheral blood progenitor cells. In this commentary, consideration is given as to whether pediatric oncology and transplant patients might benefit from modern granulocyte transfusion therapy. If children are found to experience significant morbidity or mortality from neutropenic infections despite modern supportive care, it is logical to explore the efficacy, potential toxicity, and cost-effectiveness of granulocyte transfusion therapy by properly designed, randomized clinical trials.