EFFICACY OF GRANULOCYTE TRANSFUSION FOR SEVERE METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS INFECTION AFTER HIGH-DOSE CYTARABINE FOR ACUTE MYELOGENOUS LEUKEMIA

Abstract

A 27-year-old man with acute myelogenous leukemia (AML, M2) who was in complete remission following induction therapy was treated with high-dose cytosine arabinoside (HDAraC). He subsequently developed severe pneumonia, caused by methicillin-resistant Staphylococcus aureus (MRSA), as a result of bone marrow suppression. In spite of treatment with antibiotics, granulocyte colony-stimulating factor (G-CSF) and intravenous immunoglobulin therapy (IVIG), his condition deteriorated into respiratory failure, and he required artificial respiration support. He later relapsed, but achieved complete remission following two courses of re-induction chemotherapy. He was treated with HDAraC again, which once more led to severe MRSA infection. He was then transfused granulocytes from a sibling donor by the apheresis method combined with antibiotics, G-CSF and IVIG, which resulted in a clinical improvement. Antibiotics and IVIG are widely employed in the treatment of severe bacterial infections in patients with hematological malignancies; however the effect of IVIG is not fully obtained in neutropenic conditions, since immunoglobulin requires the co-operation of neutrophils to be effective against bacterial infection. In our case, granulocyte transfusion (GTX) appeared to have prevented the deterioration of MRSA infection, suggesting that combination therapy with antibiotics, IVIG and GTX might be valuable in critically neutropenic patients suffering from severe infection.