Tanja Netelenbos1, Edwin Massey2, Liesbeth C de Wreede3, Kay Harding2, Angela Hamblin4, Mallika Sekhar5, Anna Li5, Paula F Ypma6, Lynn Ball7, Jaap Jan Zwaginga1,8, Simon J Stanworth4. 1. Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands. 2. University Hospitals Bristol NHS Foundation Trust and NHS Blood and Transplant Bristol, Bristol, United Kingdom. 3. Medical Statistics Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands. 4. Oxford University Hospitals NHS Foundation Trust & Oxford BRC Hematology Theme Oxford, Oxford, United Kingdom. 5. Department of Hematology, Royal Free Hospital London, London, United Kingdom. 6. Department of Hematology, HAGA Hospital, The Hague, the Netherlands. 7. Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands. 8. Center for Clinical Transfusion Research, Sanquin-LUMC, Leiden, the Netherlands.
Abstract
BACKGROUND: Patients with prolonged neutropenia caused by chemotherapy or underlying marrow disorders are at risk of invasive bacterial and fungal infections. New treatment options alongside targeted antimicrobial therapy that might improve outcomes include granulocyte transfusions (GTX). To inform the research agenda, a prospective observational cohort study was performed in the Netherlands and United Kingdom. The aim was to describe the incidence, characteristics, and outcomes of patients developing invasive infections and assess patients fulfilling criteria for GTX. STUDY DESIGN AND METHODS: All patients receiving myeloablative chemotherapy and anticipated to develop 7 or more days of neutropenia (<0.5 × 109 /L) were eligible and followed for the development of invasive infections according to a defined algorithm and mortality up to 100 days. Secondary outcomes were types of infection and eligibility for GTX. RESULTS: A total of 471 patients enrolled at six hematology-oncology departments were followed for 569 neutropenic episodes. Overall, 32.5% of patients developed invasive infections during their first episode. Significant baseline risk factors for developing infections were high comorbidity scores (WHO performance status ≥ 2, hazard ratio [HR], 2.6 [1.7-3.9]; and hematopoietic cell transplantation-comorbidity index score ≥ 2 HR 1.3 [0.9-1.8]). Infections were bacterial (59.4%) and fungal (22.3%). Despite 34 patients (6.3% of all episodes) appearing to meet criteria to receive GTX, only nine patients received granulocytes. The HR for death was 5.8 (2.5-13.0) for patients with invasive infections. CONCLUSION: This study documents that invasive infections are associated with significant mortality. There is a need for new strategies to prevent and treat infections, which may include better understanding of use GTX.
BACKGROUND:Patients with prolonged neutropenia caused by chemotherapy or underlying marrow disorders are at risk of invasive bacterial and fungal infections. New treatment options alongside targeted antimicrobial therapy that might improve outcomes include granulocyte transfusions (GTX). To inform the research agenda, a prospective observational cohort study was performed in the Netherlands and United Kingdom. The aim was to describe the incidence, characteristics, and outcomes of patients developing invasive infections and assess patients fulfilling criteria for GTX. STUDY DESIGN AND METHODS: All patients receiving myeloablative chemotherapy and anticipated to develop 7 or more days of neutropenia (<0.5 × 109 /L) were eligible and followed for the development of invasive infections according to a defined algorithm and mortality up to 100 days. Secondary outcomes were types of infection and eligibility for GTX. RESULTS: A total of 471 patients enrolled at six hematology-oncology departments were followed for 569 neutropenic episodes. Overall, 32.5% of patients developed invasive infections during their first episode. Significant baseline risk factors for developing infections were high comorbidity scores (WHO performance status ≥ 2, hazard ratio [HR], 2.6 [1.7-3.9]; and hematopoietic cell transplantation-comorbidity index score ≥ 2 HR 1.3 [0.9-1.8]). Infections were bacterial (59.4%) and fungal (22.3%). Despite 34 patients (6.3% of all episodes) appearing to meet criteria to receive GTX, only nine patients received granulocytes. The HR for death was 5.8 (2.5-13.0) for patients with invasive infections. CONCLUSION: This study documents that invasive infections are associated with significant mortality. There is a need for new strategies to prevent and treat infections, which may include better understanding of use GTX.
Authors: Ka-Won Kang; Byung-Hyun Lee; Min Ji Jeon; Eun Sang Yu; Dae Sik Kim; Se Ryeon Lee; Hwa Jung Sung; Chul Won Choi; Yong Park; Byung Soo Kim Journal: Ther Adv Hematol Date: 2020-10-20
Authors: Pinkal M Desai; Janice Brown; Saar Gill; Melham M Solh; Luke P Akard; Jack W Hsu; Celalettin Ustun; Charalambos Andreadis; Olga Frankfurt; James M Foran; John Lister; Gary J Schiller; Matthew J Wieduwilt; John M Pagel; Patrick J Stiff; Delong Liu; Irum Khan; Wendy Stock; Suman Kambhampati; Martin S Tallman; Lawrence Morris; John Edwards; Iskra Pusic; Hagop M Kantarjian; Richard Mamelok; Alicia Wong; Rodney Van Syoc; Lois Kellerman; Swapna Panuganti; Ramkumar Mandalam; Camille N Abboud; Farhad Ravandi Journal: J Clin Oncol Date: 2021-06-22 Impact factor: 50.717