Granulocyte transfusion improves survival in pediatric febrile neutropenia: a 15-year cohort study

Background: Febrile neutropenia (FN) remains a leading cause of morbidity and mortality in pediatric patients with high-risk hematologic disorders, particularly in low-and middle-income countries (LMICs), where antimicrobial resistance limits treatment options. Granulocyte transfusion (GT) is considered an adjunctive therapy; however, pediatric data from LMICs are limited. Purpose: This study evaluates the effectiveness, timing, and safety of GT in a real-world LMIC setting. Methods: This 15-year retrospective cohort study included pediatric patients (≤18 years) with severe neutropenic infections treated at a national tertiary referral center in Thailand in 2009–2023. The patients received GT plus antimicrobial therapy or antimicrobial therapy alone. The primary outcome measure was 30-day survival. The analyses included multivariate logistic regression, Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW). Results: Among the 54 patients (26 GT recipients; 28 controls), GT was associated with improved 30-day survival in the full cohort (odds ratio [OR], 0.105; 95% confidence interval [CI], 0.016–0.700; P=0.020). IPTW confirmed this association (OR, 0.099; P=0.001), with consistent results in the PSM analysis (OR, 0.157; P=0.028). In the high-risk hematologic condition subgroup (n=48), GT was associated with increased survival (95.2% vs. 61.9%; hazard ratio [HR], 0.105; P=0.034). GT also accelerated the resolution of fever (HR, 2.24; P=0.028), FN recovery (HR, 2.35; P=0.017), and absolute neutrophil count recovery (HR, 2.10; P=0.047). No serious transfusion-related adverse events were observed. Conclusion: GT was associated with improved survival and faster clinical recovery in pediatric patients with FN. These real-world LMIC data support its use as a feasible adjunctive therapy and warrant prospective validation.