Granulocyte transfusions in the management of invasive fungal infections

Abstract

Granulocyte transfusions have a long history of being used in patients with neutropenia or neutrophil dysfunction to prevent and treat invasive fungal infections. However, there are limited and conflicting data concerning its clinical effectiveness, considerable variations in current granulocyte transfusion practices, and uncertainties about its benefit as an adjunct to modern antifungal therapy. In this review, we provide an overview on granulocyte transfusions and summarize the evidence on their role in the prevention and treatment of invasive fungal infections.

Keywords: fungal infection; granulocytes; leukapheresis; neutropenia; transfusions.

Figure 1

Neutrophil-mediated intracellular and extracellular killing of fungal pathogens. During phagocytosis, neutrophil azurophilic granules fuse with the phagosome and release contents (cathepsin G, elastase, proteinase 3, and myeloperoxidase) into the phagocytic vacuole. For larger structures like fungal hyphae, the neutrophil releases web-like extracellular traps (NETs) composed of decondensed chromatin in complex with antimicrobial proteins that trap and neutralize pathogens. Adapted with permission from Macmillan Publishers Ltd: (Wheeler, M.L. & Underhill, D. M. Time to cast a larger net. Nature Immunology, 11, 1000–1001), copyright (2014).