Efficacy of Granulocyte Transfusions in Treating Neutropenic Infections: A Systematic Review and Meta-Analysis of Intervention Studies

The therapeutic value of granulocyte transfusions (GTX) remains debated. We conducted a systematic review and meta-analysis of intervention studies evaluating GTX efficacy in treating neutropenic infections. MEDLINE, EMBASE, and Cochrane Central were searched from inception to March 2025 to identify interventional studies evaluating the efficacy of GTX for neutropenic infections. Studies were qualitatively summarized. Summary risk ratios (RR) with 95% confidence intervals (CIs) were estimated for randomized controlled trials (RCTs), and non-randomized controlled trials (NRCTs) using random-effects models. Certainty of evidence was evaluated using GRADE. There were 110 studies meeting inclusion criteria: 16 RCTs, 14 NRCTs, and 80 uncontrolled trials. The most frequent underlying disease was leukemia, and the most frequently reported pathogen was Candida. In RCTs, GTX showed no significant all-cause mortality reduction over standard-of-care in pediatric/adult patients or neonates, both associations with low certainty of evidence. In contrast, prospective NRCTs including pediatric/adult patients showed that GTX led to lower all-cause mortality (RR 0.40; 95% CI: 0.23-0.68, I²: 64%), particularly among recipients of high-dose GTX (≥1 × 10¹⁰cells/transfusion), with very low-certainty evidence. Results support a dose-response relationship and highlight heterogeneity in patients, treatment settings, and infections. This work recommends carefully designed future RCTs, including strict patient stratification.