Non-irradiated GCSF stimulated leukocyte transfusion for necrotizing fasciitis after allogeneic stem cell transplant: a case report and review of the literature

• Published in: Bone marrow transplantation (Basingstoke) 2020-06, Vol.55 (6), p.1000-1003
• Main Authors: Moukalled, Nour, Bou Akl, Imad, Al Masri, Ahmad, Kanafani, Zeina, EL-Cheikh, Jean, Bazarbachi, Ali
• Format: Article
• Language: English
• Subjects: 692/308; 692/699; Anidulafungin; Antibiotics; Antithymocyte globulin; Bone marrow; Care and treatment; Case reports; Cell Biology; Clinical trials; Colony-stimulating factor; Complications; Complications and side effects; Fasciitis; Fasciitis, Necrotizing - etiology; Fasciitis, Necrotizing - therapy; Granulocyte Colony-Stimulating Factor; Granulocytes; Hematological diseases; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Infection; Infection control; Infections; Internal Medicine; Leukocyte Transfusion; Leukocytes; Leukocytes (granulocytic); Literature reviews; Medical treatment; Medicine; Medicine & Public Health; Metronidazole; Necrotizing fasciitis; Neutropenia; Public Health; Review Article; Safety; Stem Cell Transplantation; Stem Cells; Therapeutic applications; Transfusion; Transplantation; Transplants & implants
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-019-0743-6

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.