Schiffer 1979.

Methods	Parallel RCT (recruitment period not reported). Single centre. Country: USA
Participants	Inclusion criteria: Previously untreated adults (> 18 years) with acute myeloid leukaemia. Exclusion criteria: excluded infected patients and patients on systemic antibiotics Total randomised: N = 22 Total analysed: N = 18 Arm 1 (Granulocyte transfusions): randomised = 12, analysed = 9 , Acute myeloid leukaemia = 12 Arm 2 (Control): randomised = 10, analysed = 9 , Acute myeloid leukaemia = 10
Interventions	Comparison between prophylactic platelet transfusions on alternate days (3 to 4 out of 7 days) versus prophylactic granulocyte and platelet transfusions on alternate days (4 out of 7 days) Granulocyte dose: 1.15 x 1010 (0.34 to 2.4) Granulocyte method of collection: intermittent flow centrifugation Donor premedication: dexamethasone Initiation of granulocyte transfusions: Neutrophil count < 0.5 x 109/L or platelet count < 20 x 109/L Frequency of granulocyte transfusions: Four days out of seven each week Termination of granulocyte transfusions: Until recovery (or rising neutrophil count > 0.5 x 109/L with no dependence on platelet transfusions
Outcomes	Primary Outcomes: Microbiologically or clinically documented severe infection and detected alloimmunisation Other Outcomes: Mortality/survival, fever (days or episodes), infection (days or episodes), antibiotic use, adverse events
Definition of infection	Febrile day ‐ not reported Febrile episode ‐ temperature > 38.3oC Proven infection: ‐ not reported
Definition of neutropenia	Not reported but the 'trigger' neutrophil count was 0.5 x 109/L
Co‐interventions	Prophylactic antibiotics: all participants received oral non‐absorbable antibiotics Therapeutic antibiotics: empirical systemic antibiotics were started if the temperature was > 38.3oC and / or there was clinical evidence of infection but the nature of these antibiotics were not stated. Therapeutic granulocyte transfusions: not reported
Notes	Funding Sources: Not reported Conflict of Interests: Not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Method of sequence generation was not reported
Allocation concealment (selection bias)	Unclear risk	Method of allocation concealment was not reported
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	It was not reported whether participants were blinded to the intervention. It was not reported whether clinicians or investigators were blinded to the intervention.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	It was not reported whether outcome assessors were blinded to the intervention
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Ten participants were randomised to the control. One participant developed alloimmunisation after her first platelet transfusion and was not continued in the study. 12 participants were randomised to receive granulocyte transfusions. Two participants developed infections prior to receiving their first granulocyte transfusion and were excluded from the study. A third participant refused further granulocyte transfusions after two severe transfusion reactions.
Selective reporting (reporting bias)	Unclear risk	The protocol was not available to assess whether any pre‐specified outcomes were not reported or outcomes were reported that were not pre‐specified
Other bias	Unclear risk	Two participants in the control group had acute promyelocytic leukaemia and developed disseminated intravascular coagulation. This could have increased the risk of mortality in the control arm.