Granulocyte transfusion: a review

Neutrophils are the body's main defence against invasion by bacteria and fungi and, below a level of 1 x 10(9)/l, there is a direct relationship between their circulating number and the risk of systemic infection. Despite advances in supportive care, such as improved broad-spectrum antibiotics and the haemopoietic growth factors, neutropenia following myelosuppressive chemotherapy for malignant disease remains the most important cause of treatment-related morbidity and mortality and its most important dose-limiting toxicity. Although there is clear theoretical, experimental and anecdotal clinical evidence supporting the use of transfused granulocytes to prevent and treat infection in neutropenia, early attempts at exploiting this clinically were unsuccessful, mainly because of difficulties in collecting a sufficient number of cells. Improvements in the technology of collection, including the use of red cell sedimenting agents, glucocorticoids and, more recently, granulocyte-colony-stimulating factor, now allow granulocyte doses within the therapeutic range to be routinely collected. Preliminary evidence suggests clinical efficacy. However, well-designed trials with clinically relevant end-points will be required before granulocyte transfusion can become part of routine clinical practice.