| Granulocyte transfusion improves survival in pediatric febrile neutropenia: a 15-year cohort study |
Witsanu Phetsai1 
, Kleebsabai Sanpakit1
, Jassada Buaboonnam1
, Kamon Phuakpet1
, Nassawee Vathana1
, Nattee Narkbunnam1
, Fon Kladed2
, Chayamon Takpradit1
|
1Division of Hematology and Oncology, Department of Pediatrics Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2Department of Transfusion Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, Bangkok, Thailand |
Correspondence:
Chayamon Takpradit, Email: dakarnda025@gmail.com
|
|
Received: 30 May 2025 • Revised: 1 October 2025 • Accepted: 9 October 2025 |
|
|
| Abstract |
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. |
| Key Words:
Granulocyte transfusion, Febrile neutropenia, Pediatric hematology, Survival, Infection |
|
PDF Links
Download Citation
