Work

Efficacy of Granulocyte Transfusions in Treating Neutropenic Infections: A Systematic Review and Meta-Analysis of Intervention Studies

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: • Granulocyte transfusions showed no impact on all-cause mortality in RCTs. • Granulocyte transfusions reduced all-cause mortality in prospective NRCTs. • All-cause mortality reduction is pronounced with high-dose granulocyte transfusion. • Acute leukemia is the most frequent underlying disease in neutropenic patients. • Candida, Klebsiella, and Aspergillus are the most frequent infectious agents. The therapeutic value of granulocyte transfusions (GTX) remains debated. We conducted a systematic review and meta-analysis of intervention studies evaluating GTX efficacy in treating neutropenic infections. MEDLINE, EMBASE, and Cochrane Central were searched from inception to March 2025 to identify interventional studies evaluating the efficacy of GTX for neutropenic infections. Studies were qualitatively summarized. Summary risk ratios (RR) with 95% confidence intervals (CIs) were estimated for randomized controlled trials (RCTs), and non-randomized controlled trials (NRCTs) using random-effects models. Certainty of evidence was evaluated using GRADE. There were 110 studies meeting inclusion criteria: 16 RCTs, 14 NRCTs, and 80 uncontrolled trials. The most frequent underlying disease was leukemia, and the most frequently reported pathogen was Candida . In RCTs, GTX showed no significant all-cause mortality reduction over standard-of-care in pediatric/adult patients or neonates, both associations with low certainty of evidence. In contrast, prospective NRCTs including pediatric/adult patients showed that GTX led to lower all-cause mortality (RR 0.40; 95% CI: 0.23-0.68, I 2 : 64%), particularly among recipients of high-dose GTX (≥1 × 10 10 cells/transfusion), with very low-certainty evidence. Results support a dose-response relationship and highlight heterogeneity in patients, treatment settings, and infections. This work recommends carefully designed future RCTs, including strict patient stratification.

Source: Transfusion Medicine Reviews

DOI: 10.1016/j.tmrv.2025.150929

Authors: Alejandra López-Arredondo, Saúl Karr de León, Anna-Maria Lampousi, Marion E.G. Brunck

Institutions: Tecnológico de Monterrey, Karolinska Institutet, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Universidad Nacional Autónoma de México

Language: English

Topic: Neutropenia and Cancer Infections

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,970