Abstract
Severe neutropenia remains among the most common complications associated with hematological diseases and their treatment, especially in the early poststem cell transplantation. Managing life-threatening infections associated with prolonged and profound neutropenia thus remains an essential component for the optimal care of patients undergoing transplant. Several therapeutic interventions have been attempted either to limit the duration of neutropenia through granulocyte colony stimulating factors (GCSF), or to treat associated infections through the use of granulocyte transfusions. The efficacy and safety of granulocyte transfusions have been controversial, and the conflicting results reported by several trials can be explained by the significant variability related to patient selection, timing of initiation, and duration of transfusions, preparation methods among multiple others. We herein report a case of life-threatening necrotizing fasciitis post haploidentical stem cell transplant, responding to the combination of antibiotics and daily transfusions of non-irradiated GCSF stimulated leukocytes from healthy donors without surgical intervention. We also provide a concise review of the available literature regarding the use of this intervention, its efficacy and safety and comparison of irradiated with non-irradiated transfusions.
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Acknowledgements
We thank the nursing staff for providing excellent care for our patients and the physicians in the Hematology and Oncology division, various departments at the American University of Beirut Medical Center and referring physicians from Lebanon and the Middle East region for their significant contributions and dedicated patient care.
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NM collected data, provided clinical care, wrote and revised the manuscript. AM provided clinical care, contributed to and commented on the manuscript. IB provided clinical care, critical care support, and commented on the manuscript. ZK provided clinical care and commented on the manuscript. JE-C collected and analyzed data, provided clinical care, commented on and revised the manuscript. AB designed transplant program, provided clinical care, contributed to manuscript writing and edited the manuscript. All authors approved submission of the manuscript for publication purposes.
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Moukalled, N., Bou Akl, I., Al Masri, A. et al. Non-irradiated GCSF stimulated leukocyte transfusion for necrotizing fasciitis after allogeneic stem cell transplant: a case report and review of the literature. Bone Marrow Transplant 55, 1000–1003 (2020). https://doi.org/10.1038/s41409-019-0743-6
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DOI: https://doi.org/10.1038/s41409-019-0743-6