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NCT00627393 · CITED IN SOURCE DOCUMENTS

Safety and Effectiveness of Granulocyte Transfusions in Resolving Infection in People With Neutropenia (The RING Study)

An NCI or FDA source cites this study. A citation does not establish that it applies to an individual diagnosis.

Phase
PHASE3
Status at capture
COMPLETED
Registry last update
2015-04-17

Neutropenia, a condition characterized by an abnormally low number of infection-fighting white blood cells called neutrophils, commonly develops in people who have undergone chemotherapy or hematopoietic stem cell (HSC) transplantation. The severely reduced immunity of those with neutropenia can put them at risk of entry of life-threatening infections, making the implementation of treatments that increase white blood cell numbers important. Several studies have shown that the transfusion of donor granulocytes, a type of white blood cell that includes neutrophils, is effective in promoting the recovery of adequate numbers of granulocytes. However, granulocyte transfusions can cause side effects, and it is not known whether the success of the therapy outweighs the health risks of the side effects. This study will evaluate the safety and effectiveness of granulocyte transfusions in treating people with a bacterial or fungal infection during neutropenia.

Open the original ClinicalTrials.gov record → · Download preserved record

What did the study report?

Outcomes, safety and baseline populations are separate source sections. Quality-of-life measures appear under their original outcome titles.

flow

Participant flow

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baseline

Baseline characteristics

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outcome · POSTED

Percentage of Participants Who Are Alive at 42 Days After Treatment and Have Had Microbial Response

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outcome · NOT POSTED

Alloimmunization, Defined as the Appearance of Anti-human Leukocyte Antigen (HLA) or Antineutrophil Antibodies

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outcome · POSTED

Serious Granulocyte Transfusion Reactions, Including Febrile, Allergic, and Pulmonary Reactions (Transfusion Arm Only)

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outcome · POSTED

Graft Versus Host Disease Among Recipients of Allogeneic Stem Cell Transplantation

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outcome · POSTED

Overall Incidence of Adverse Effects

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outcome · POSTED

Fever Resolution

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outcome · NOT POSTED

Time to Negative Test for Fungal Antigenemia (e.g., Galactomannan Antigenemia Among Participants With Invasive Aspergillosis)

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outcome · NOT POSTED

Time to Negative Blood Culture for Participants With Positive Blood Culture at Baseline

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outcome · POSTED

Long-term Survival

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outcome · POSTED

Serious Adverse Events in Granulocyte Donors

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outcome · POSTED

Donor Availability (Proportion of Scheduled Granulocyte Transfusion Days on Which Granulocytes Were Available)

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outcome · POSTED

Evaluation of Granulocyte Yield

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outcome · NOT POSTED

Discontinuation of Granulocyte Transfusions Due to Toxicity or Intolerance

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adverse events

Adverse events

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more info

Limitations, agreements, and source contact

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Who could take part
eligibility Criteria
Inclusion Criteria: * Severe neutropenia (Absolute Neutrophil Count \< 500/mm\^3) due to marrow failure caused by underlying disease or therapy * Must have one of the following: fungemia; bacteremia; proven or presumptive invasive tissue bacterial infection; or proven, probable, or presumptive invasive fungal infection Exclusion Criteria: * Unlikely to survive 5 days * Evidence that patient will not be neutropenic at least 5 days * Previously enrolled in this study
healthy Volunteers
false
sex
ALL
std Ages
  1. CHILD
  2. ADULT
  3. OLDER_ADULT
Treatment arms and interventions
arm Groups
  1. description
    Participants will receive granulocyte transfusions in addition to standard antimicrobial therapy
    intervention Names
    1. Drug: Standard antimicrobial therapy
    2. Biological: Granulocyte transfusions
    label
    1
    type
    EXPERIMENTAL
  2. description
    Participants will receive standard antimicrobial therapy alone
    intervention Names
    1. Drug: Standard antimicrobial therapy
    label
    2
    type
    ACTIVE_COMPARATOR
  3. description
    Participants will donate granulocytes after receiving a combination of two drugs, G-CSF and dexamethasone
    intervention Names
    1. Drug: G-CSF/dexamethasone
    2. Device: Apheresis machine
    label
    3
    type
    OTHER
interventions
  1. arm Group Labels
    1. 1
    2. 2
    description
    Antimicrobial therapy is broadly defined as therapy within the standard of care for a particular infection and should be consistent within a given institution. Participants will undergo the recommended therapy for specific infections for 42 days.
    name
    Standard antimicrobial therapy
    type
    DRUG
  2. arm Group Labels
    1. 1
    description
    Participants will receive one granulocyte transfusion per day until one of the following occurs: recovery from neutropenia, life-threatening toxicity, resolution or improvement of infection, or Day 42 after treatment. Granulocyte content of each transfusion is targeted to be at least 4 x 10\^10 per collection (or proportionately less for participants less than 30 kg in weight).
    name
    Granulocyte transfusions
    type
    BIOLOGICAL
  3. arm Group Labels
    1. 3
    description
    Twelve hours before each donation, participants will be injected with G-CSF and will take one dose of dexamethasone by mouth.
    name
    G-CSF/dexamethasone
    other Names
    1. Neupogen
    type
    DRUG
  4. arm Group Labels
    1. 3
    description
    Participants will undergo a procedure using an apheresis machine for granulocyte collection. The procedure will last 3 to 4 hours and will involve the drawing of blood from each arm, the separation of granulocytes from the red cells and plasma in the machine, and the return of the red cells and plasma to the participants.
    name
    Apheresis machine
    type
    DEVICE
Study design
allocation
RANDOMIZED
intervention Model
PARALLEL
masking Info
masking
SINGLE
who Masked
  1. OUTCOMES_ASSESSOR
primary Purpose
TREATMENT
Enrollment
count
114
type
ACTUAL
Registered outcome plans (not posted results)
primary Outcomes
  1. description
    Microbial response was defined as follows: * A negative blood culture test at 42 days after randomization for subjects with fungemia (candidemia or fusariosis) or bacteremia. * Improvement of signs and symptoms of infectious disease (complete or partial response) at 42 days after randomization.
    measure
    Percentage of Participants Who Are Alive at 42 Days After Treatment and Have Had Microbial Response
    time Frame
    Measured at Day 42
secondary Outcomes
  1. measure
    Alloimmunization, Defined as the Appearance of Anti-human Leukocyte Antigen (HLA) or Antineutrophil Antibodies
    time Frame
    Measured at Days 14 and 42
  2. measure
    Serious Granulocyte Transfusion Reactions, Including Febrile, Allergic, and Pulmonary Reactions (Transfusion Arm Only)
    time Frame
    Measured within 6 hours after end of transfusion
  3. description
    Time to GVHD incidence between the two treatment groups was compared using Gray's model that takes into account death as a competing risk.
    measure
    Graft Versus Host Disease Among Recipients of Allogeneic Stem Cell Transplantation
    time Frame
    Measured at Day 42
  4. measure
    Overall Incidence of Adverse Effects
    time Frame
    Measured through Day 42
  5. description
    Fever resolution between the two treatment groups was compared using Gray's model that takes into account death as a competing risk.
    measure
    Fever Resolution
    time Frame
    Measured through Day 42
  6. measure
    Time to Negative Test for Fungal Antigenemia (e.g., Galactomannan Antigenemia Among Participants With Invasive Aspergillosis)
    time Frame
    Measured at Days 7, 14, and 42
  7. measure
    Time to Negative Blood Culture for Participants With Positive Blood Culture at Baseline
    time Frame
    Measured through Day 42
  8. measure
    Long-term Survival
    time Frame
    Measured at Month 3
  9. measure
    Serious Adverse Events in Granulocyte Donors
    time Frame
    Measured at Week 1 after G-CSF administration
  10. measure
    Donor Availability (Proportion of Scheduled Granulocyte Transfusion Days on Which Granulocytes Were Available)
    time Frame
    Measured through study completion
  11. measure
    Evaluation of Granulocyte Yield
    time Frame
    Measured immediately after each granulocyte donation
  12. measure
    Discontinuation of Granulocyte Transfusions Due to Toxicity or Intolerance
    time Frame
    Measured through Day 42
Full study description
brief Summary
Neutropenia, a condition characterized by an abnormally low number of infection-fighting white blood cells called neutrophils, commonly develops in people who have undergone chemotherapy or hematopoietic stem cell (HSC) transplantation. The severely reduced immunity of those with neutropenia can put them at risk of entry of life-threatening infections, making the implementation of treatments that increase white blood cell numbers important. Several studies have shown that the transfusion of donor granulocytes, a type of white blood cell that includes neutrophils, is effective in promoting the recovery of adequate numbers of granulocytes. However, granulocyte transfusions can cause side effects, and it is not known whether the success of the therapy outweighs the health risks of the side effects. This study will evaluate the safety and effectiveness of granulocyte transfusions in treating people with a bacterial or fungal infection during neutropenia.
detailed Description
Thousands of people each year are hospitalized for neutropenia, which continues to cause substantial morbidity and mortality for those affected. Neutropenia is primarily caused by chemotherapy and various other cancer treatments, such as radiation therapy, biotherapy, and HSC transplantation. Signs and symptoms of neutropenia may include high fever, chills, sore throat, and diarrhea. In neutropenia, the number of neutrophils, a type of granulocyte, is greatly reduced, weakening the body's immune system and increasing the risk of infection. Therefore, a method to provide adequate numbers of functional granulocytes to people with neutropenia could be of greatest benefit for recovery. Administration of a combination of two drugs, granulocyte colony-stimulating factor (G-CSF) and dexamethasone, has been show to stimulate the body to produce a large number of granulocytes. Granulocyte transfusions obtained from donors who have received these two drugs may help people with low white blood cell counts fight infections until their own white blood cell counts recover. However, it is not clear whether the benefits of granulocyte transfusions outweigh the risks of side effects. This study will compare the safety and effectiveness of granulocyte transfusions with standard antimicrobial therapy versus the safety and effectiveness of standard antimicrobial therapy alone in increasing granulocyte numbers and in improving survival rates in people with bacterial or fungal infection during neutropenia. Participation in the research portion of this study will last about 3 months. All participants who were not previously receiving treatment with standard antimicrobial therapy will begin therapy immediately upon study entry. Participants will then be assigned randomly to receive either granulocyte transfusion plus continued antimicrobial therapy or continued antimicrobial therapy alone. All participants will be monitored for a maximum of 42 days, during which they will provide information on medical history and ongoing status of antimicrobial therapy. Daily blood samples to measure white blood cell count will be obtained from participants until samples show that participants are making their own granulocytes. Samples will then be collected weekly until Day 42. There may be additional blood draws depending on the type of infection present in participants. Granulocyte transfusions will be given daily during the 42-day treatment period, depending on granulocyte donor availability. Blood counts will be checked immediately before and after each transfusion to measure granulocyte levels. Transfusions will be stopped if participants start making their own granulocytes, experience serious side effects, or show a reduction in infection. At Month 3 after study entry, follow-up information will be collected about all participants' health status through reviewing their medical records and contacting their physicians. Participation for granulocyte donors will last 1 week from the time of donation. Community donors may provide more than one granulocyte donation, but no more than one donation every 3 days. Frequency of donation from a family member will be according to local blood bank criteria with approval from a blood bank physician. Both community donors and family donors are limited to eight donations each year. Twelve hours before each donation, participants will be injected with Neupogen, which contains G-CSF, and they will take one dose of dexamethasone by mouth. Participants will then undergo a blood draw, followed by a procedure using an apheresis machine for granulocyte collection. The procedure will last 3 to 4 hours and will involve the drawing of blood from each arm, the separation of granulocytes from the red blood cells and plasma in the machine, and the return of the red blood cells and plasma to the participants.
Source references
references
  1. citation
    Price TH, Boeckh M, Harrison RW, McCullough J, Ness PM, Strauss RG, Nichols WG, Hamza TH, Cushing MM, King KE, Young JA, Williams E, McFarland J, Holter Chakrabarty J, Sloan SR, Friedman D, Parekh S, Sachais BS, Kiss JE, Assmann SF. Efficacy of transfusion with granulocytes from G-CSF/dexamethasone-treated donors in neutropenic patients with infection. Blood. 2015 Oct 29;126(18):2153-61. doi: 10.1182/blood-2015-05-645986. Epub 2015 Sep 2.
    pmid
    26333778
    type
    DERIVED
Source notices and limitations
    Discovery and provenance
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        02" tabindex="-1">No good evidence exists to support granulocyte transfusions in the treatment of AML. A multicenter randomized trial (<a href="/clinicaltrials/NCT00627393">RING</a> [NCT00627393]) was conducted to address the utility of granulocyte transfusions in the setting of infections.[<a href="#cit/section_3.11">11</a>] The
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        od evidence exists to support granulocyte transfusions in the treatment of AML. A multicenter randomized trial (<a href="/clinicaltrials/NCT00627393">RING</a> [NCT00627393]) was conducted to address the utility of granulocyte transfusions in the setting of infections.[<a href="#cit/section_3.11">11</a>] There was no difference be
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      source update dates
      1. context
        Updated: March 14, 2025
        datetime
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        display
        March 14, 2025

    Preserved source evidence · Not medical advice