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

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