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Granulocyte transfusion improves survival in pediatric febrile neutropenia: a 15-year cohort study
Witsanu Phetsai1, Kleebsabai Sanpakit1, Jassada Buaboonnam1
1Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Granulocyte transfusion (GT) improved survival and recovery for children with febrile neutropenia (FN) in low-resource settings. This study supports GT as a safe and effective adjunctive therapy in these challenging environments.
Area of Science:
- Hematology
- Pediatric Oncology
- Infectious Diseases
Background:
- Febrile neutropenia (FN) is a critical cause of mortality in pediatric patients with hematologic disorders, especially in low- and middle-income countries (LMICs) with limited treatment options due to antimicrobial resistance.
- Granulocyte transfusion (GT) is a potential adjunctive therapy, but pediatric data from LMICs are scarce.
Purpose of the Study:
- To evaluate the effectiveness, optimal timing, and safety of Granulocyte transfusion (GT) in a real-world setting within a low- and middle-income country (LMIC).
Main Methods:
- A 15-year retrospective cohort study involving pediatric patients (≤18 years) with severe neutropenic infections treated in Thailand.
- Comparison of outcomes between patients receiving GT plus antimicrobial therapy and those receiving antimicrobial therapy alone.
- Statistical analyses included multivariate logistic regression, Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) to assess 30-day survival.
Main Results:
- Granulocyte transfusion (GT) was associated with significantly improved 30-day survival in the overall cohort (OR, 0.105; P=0.020) and confirmed by IPTW (OR, 0.099; P=0.001) and PSM (OR, 0.157; P=0.028).
- In the high-risk hematologic subgroup, GT recipients showed higher survival rates (95.2% vs. 61.9%; HR, 0.105; P=0.034).
- GT accelerated fever resolution (HR, 2.24; P=0.028), FN recovery (HR, 2.35; P=0.017), and absolute neutrophil count recovery (HR, 2.10; P=0.047) with no serious adverse events.
Conclusions:
- Granulocyte transfusion (GT) demonstrates significant benefits in improving survival and accelerating clinical recovery for pediatric patients experiencing febrile neutropenia (FN).
- These findings from a low- and middle-income country (LMIC) setting suggest that GT is a feasible and effective adjunctive therapy.
- Further prospective studies are warranted to validate these promising results.
Background:
Febrile neutropenia (FN) remains a leading cause of morbidity and mortality in pediatric patients with high-risk hematologic disorders, particularly in low- and middle-income countries (LMICs), where antimicrobial resistance limits treatment options. Granulocyte transfusion (GT) is considered an adjunctive therapy; however, pediatric data from LMICs are limited.
Purpose:
This study evaluates the effectiveness, timing, and safety of GT in a real-world LMIC setting.
Methods:
This 15-year retrospective cohort study included pediatric patients (≤18 years) with severe neutropenic infections treated at a national tertiary referral center in Thailand in 2009-2023. The patients received GT plus antimicrobial therapy or antimicrobial therapy alone. The primary outcome measure was 30-day survival. The analyses included multivariate logistic regression, Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW).
Results:
Among the 54 patients (26 GT recipients; 28 controls), GT was associated with improved 30-day survival in the full cohort (odds ratio [OR], 0.105; 95% confidence interval [CI], 0.016-0.700; P=0.020). IPTW confirmed this association (OR, 0.099; P=0.001), with consistent results in the PSM analysis (OR, 0.157; P=0.028). In the high-risk hematologic condition subgroup (n=48), GT was associated with increased survival (95.2% vs. 61.9%; hazard ratio [HR], 0.105; P=0.034). GT also accelerated the resolution of fever (HR, 2.24; P=0.028), FN recovery (HR, 2.35; P=0.017), and absolute neutrophil count recovery (HR, 2.10; P=0.047). No serious transfusion-related adverse events were observed.
Conclusion:
GT was associated with improved survival and faster clinical recovery in pediatric patients with FN. These real-world LMIC data support its use as a feasible adjunctive therapy and warrant prospective validation.
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