Table 3.

Main studies on the use of granulocyte transfusion in pediatric cohorts.

Author	Design of Study	Results and Conclusions
Sachs et al. [77]	27 children with hematologic disorder or malignancy and severe neutropenia with clinically and/or microbiologically documented severe infection (including 6 invasive aspergillosis and one disseminated candidemia) unresponsive to standard treatment received GTX.	25 out 27 patients cleared the infection, including the 6 children with aspergillosis, a great success rate, probably influenced by the low number of IFD considered and earlier start of GTX.
Pham et al. [78]	Retrospective observational analysis on GTX from stimulated and un-stimulated donors administered in pediatric HSCT patients in a single center from 2005 to 2010. In 19% of the cases, 153 GTXs were administered for IFD.	Most patients cleared the index infection, only one affected by candidemia did not. Survival between patients receiving GTX from stimulated and un-stimulated donors was not significantly different (p = 0.42). The retrospective nature of this study strongly limits its results.
Diaz et al. [79]	Retrospective review of 18 children with neutropenia or granulocyte disfunction receiving GTX.	13 patients had complete or partial response (two infections caused by Fusarium and Histoplasma spp. progressed). While the clinical benefit was evident, the retrospective nature and lack of a comparison group do not allow us to demonstrate the superiority of GTX alone against antimicrobials.
Nikolajeva et al. [80]	Retrospective analysis on 28 pediatric patients undergoing HSCT and receiving GTX (14 of them affected by proven, probable or possible IFD).	11 of the 14 patients with IFD survived, only one died for IFD progression. Interestingly, a low rate of GVHD was observed, but these results must be confirmed in larger cohorts.
Koc et al. [81]	Retrospective review on 9 pediatric hematology and oncology patients receiving GTX.	Clinical response rates after GTX was 90.9%, while mortality rate was 9%. The large limitations of this study are the small cohort considered and the absence of IFD.

GTX, granulocyte transfusion; HSCT, hematopoietic stem cell transplantation; IFD, invasive fungal disease.