Granulocyte transfusion as a treatment for enterococcal meningoencephalitis after allogeneic bone marrow transplantation from an unrelated donor

Y. Tsukada, H. Nagayama, T. Mori, T. Shimizu, N. Sato, N. Takayama, A. Ishida, M. Handa, Y. Ikeda, S. Okamoto

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Abstract

Bacterial meningoencephalitis occurring in the pre-engraftment period after bone marrow transplantation (BMT) is a rare complication, and the feasibility of granulocyte transfusion (GTX) in such cases remains to be elucidated. A 37-year-old man developed enterococcal meningoencephalitis during a severely granulocytopenic pre-engraftment period after BMT. Despite therapy with appropriate antibiotics, cultures of blood and cerebrospinal fluid (CSF) continued to grow Enterococcus faecalis, and he developed rapid mental deterioration and seizure. Granulocytes were collected from his HLA-mismatched, ABO-matched sibling with subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) and oral dexamethazone. Transfusion of 4.4 × 1010 granulocytes resulted in a 12-h post-transfusion granulocyte increment of 2.0 × 109/1, and maintained peripheral blood granulocyte counts above 0.5 × 109/l for 3 days. A rapid increase of granulocytes in CSF was also observed, and cultures of blood and CSF became negative after GTX. A transient worsening of seizure was observed as a potential side effect of GTX. The patient subsequently developed septic shock because of Pseudomonas aeruginosa and died. Further studies are warranted to evaluate the clinical efficacy of GTX for the treatment of uncontrolled infections in granulocytopenic stem cell transplant recipients.

Original languageEnglish
Pages (from-to)69-72
Number of pages4
JournalBone Marrow Transplantation
Volume31
Issue number1
DOIs
Publication statusPublished - 2003 Jan 1

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Keywords

  • Bone marrow transplantation
  • Enterococcus
  • G-CSF
  • Granulocyte transfusion
  • Meningoencephalitis

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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