Estcourt, L.J., Stanworth, S., Doree, C., Blanco, P., Hopewell, S., Trivella, M., & Massey, E. (2015). Granulocyte transfusions for preventing infections in people with neutropenia or neutrophil dysfunction. Cochrane Database of Systematic Reviews, 6, CD005341. 

STUDY PURPOSE: To determine the effectiveness and safety of prophylactic granulocyte transfusions in people with neutropenia or disorders of neutrophil functions

TYPE OF STUDY: Meta-analysis and systematic review

• DATABASES USED: MEDLINE, EMBASE, CINAHL, Cochrane Collaboration, LILACS, KoreasMed, PakMediNet, IndMED, Transfusion Evidence Library, and sites for ongoing research
• INCLUSION CRITERIA: Randomized, controlled trials or quasirandomized, controlled trials comparing patients receiving granulocyte transfusions to those not receiving granulocyte transfusions
• EXCLUSION CRITERIA: Neonates

• TOTAL REFERENCES RETRIEVED: 2,188
• EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Risk of bias according to Cochrane Handbook for Systematic Reviews of Interventions

• FINAL NUMBER STUDIES INCLUDED = 11 
• SAMPLE RANGE ACROSS STUDIES: 18–225 patients
• KEY SAMPLE CHARACTERISTICS: Patients with hematologic malignancies undergoing hematopoietic cell transplantation (HCT)

PHASE OF CARE: Active antitumor treatment

No differences in mortalit existed between those receiving and not receiving granulocyte transfusions. Three of five studies showed slightly lower number of days on antibiotics for those receiving prophylactic granulocyte transfusions. Granulocyte transfusion dosages varied. A decreased number of people receiving intermediate dosing had bacteremia and fungemia (609 patients—risk ratio [RR] = 0.45, 95% confidence interval [CI] [0.30, 0.65]). Not all endpoints could be evaluated because of varied outcomes reporting methods.

Insufficient evidence exists to detect differences in all-cause or infection-related mortality, adverse events, or duration of fever or antibiotic use between those who did and did not receive prophylactic granulocyte transfusions.

• Limited number of studies included
• Mostly low quality/high risk of bias studies
• High heterogeneity
• Highly variable dosages, frequency, and methods of granulocyte harvesting

Very limited evidence suggests the efficacy of prophylactic granulocyte transfusions for the prevention of infection in patients with cancer. The review suggests that the use of the intervention be regarded as investigational. Appropriate dosages and frequency of transfusion are unclear.