The side effects of chemotherapy, including myelosuppression, remain a major source of concern for both patients and health care providers.
Participant-reported impact of myelosuppression was significantly higher among participants aged below 50 years compared with those aged at least 50 years (p = 0.01); however, no significant differences were observed when participants were stratified by gender, employment status, cancer type, or comorbidities (depression, diabetes, hypertension).
Introduction Chemotherapy-induced myelosuppression (CIM) is one of the most common dose-limiting complications of cancer treatment, and is associated with a range of debilitating symptoms that can significantly impact patients’ quality of life.
Myelosuppression is a common side effect of chemotherapy. While this procedure is meant to destroy cancer cells, it can also affect your bone marrow and destroy your healthy blood cells. Other causes of myelosuppression include: Treating myelosuppression depends largely on the cause.
In the case of chemotherapy-induced myelosuppression, an individual's blood cell counts begin to drop 7–10 days after they begin chemotherapy. If the blood cell counts become dangerously low, doctors may reduce or stop chemotherapy to allow the bone marrow to recover.
The majority of chemotherapy drugs have been associated with myelosuppression. However, different chemo agents affect blood cell production in different ways. A list of the most common cancer drugs and their myelosuppression characteristics are listed below: Fluorouracil: all forms of myelosuppression.
Neutropenia often occurs between 7 and 12 days after you receive chemotherapy. This period can be different depending upon the chemotherapy you get. Your doctor or nurse will let you know exactly when your white blood cell count is likely to be at its lowest.
During a course of treatment, you usually have around 4 to 8 cycles of treatment. A cycle is the time between one round of treatment until the start of the next. After each round of treatment you have a break, to allow your body to recover.
Treating myelosuppression depends largely on the cause. If you're in chemotherapy, your blood cell counts will begin to decrease between 7 to 10 days after starting treatment. In mild cases of myelosuppression, treatment is not necessary. Blood count production will return to normal in a matter of weeks.
Continue until response or toxicity occurs. The first evidence of marrow improvement has been reported to occur 7 - 64 days (mean 28 days) after the beginning of therapy. In general, if a patient shows neither toxicity nor remission after a fair trial, the cautious administration of higher doses is warranted.
Chemotherapy-induced neutropenia occurred in 147 (50.5%) patients over 378 (23.4%) chemotherapy cycles. Febrile neutropenia occurred in 20 (6.9%) patients over 25 (1.5%) cycles. Febrile neutropenia occurred after cycle 1 in five (20%) cycles and within cycles 1 and 2 in 14 (56.0%) cycles.
Your neutrophil count then starts to rise again. This is because your bone marrow restarts normal production of neutrophils. But it may take 3 to 4 weeks to reach a normal level again. When your neutrophil level returns to normal, you are ready for the next round of chemotherapy.
After drug removal, most cases of neutropenia resolve over time, and only symptomatic therapy such as antibiotics for treatment and prophylaxis of infections and good hygiene practices are necessary. The average time for full recovery of the neutrophil count is 9 days (range, 9-24 days).
The effects of chemo are cumulative. They get worse with each cycle. My doctors warned me: Each infusion will get harder. Each cycle, expect to feel weaker.
How long you receive maintenance therapy depends on many factors. When used for potentially curable cancers during remission, maintenance treatment is given for a specified length of time, usually between 6 weeks and 2 years.
Nausea, vomiting, and taste changes You may experience nausea (feeling like you might throw up) and vomiting (throwing up) after your last chemotherapy treatment. It should go away in 2 to 3 weeks. Your appetite may continue to be affected due to taste changes you may have experienced during your treatment.
A decrease in red blood cells is the most common type of myelosuppression experienced by chemotherapy patients. This type of bone marrow suppression is referred to as anemia. Lowered production of white blood cells is also fairly common among cancer patients. When the chemotherapy results in the reduction of neutrophils, ...
These include: Avoiding strenuous activities such as contact sports.
Myelosuppression as a Side Effect of Chemotherapy. Myelosuppression, sometimes called bone marrow suppression, is a common side effect of chemotherapy that is characterized by a decrease in blood cell production. Three different kinds of blood cells are produced in the body's bone marrow – red blood cells, white blood cells and platelets.
Other causes of myelosuppression include nutritional deficiencies, viruses, therapeutic x-rays performed on cancer patients and cancer cells themselves.
Three different kinds of blood cells are produced in the body's bone marrow – red blood cells, white blood cells and platelets. Myelosuppression can result in the decrease in one, two or all three types of blood cells. A decrease in red blood cells is the most common type of myelosuppression experienced by chemotherapy patients.
A drop in platelet numbers is called thrombocytopenia. This type of bone marrow suppression is fairly rare, and only negatively affects less than 10 percent of all cancer patients. When an individual experiences a drop in all three types of blood cells, the condition is called pancytopenia.
Blood cell numbers typically begin to drop seven to 10 days after chemotherapy begins. Once chemotherapy is completed, blood counts should return to normal after a few weeks. In mild cases, no treatment may be necessary. However, in rare cases chemotherapy can cause irreparable damage.
The signs of myelosuppression depend on which type of blood cells are in low supply. In some cases, it causes only mild symptoms. But it also can lead to serious problems and even be life-threatening. Symptoms of anemia include: Pale skin and lips. Pale nails. Fatigue. Feeling dizzy. Weakness.
It can also be a side effect of some cancer treatments, like radiation, chemotherapy drugs, and steroids. Bone marrow is the soft, spongy tissue in the middle of your bones. It's where red blood cells, white blood cells, and platelets are made. Each of those plays a different role in ...
If you have neutropenia, they also may give you antibiotics to treat any infections. Change in medications. If you have neutropenia because of cancer treatments, your doctor may give you different chemo drugs or delay your next session.
Myelosuppression can also make your cancer treatment take longer and affect your quality of life. Tips to Prevent Issues. If your blood cell counts are low, you can make a few changes to your daily routine to stay healthy. For example:
A total of 386 women, including 179 who received no chemotherapy after mastectomy (control group) and 207 who received adjuvant combination chemotherapy, were followed for approximately 20 years.
During the use of combination chemotherapeutic regimens for nonmyeloid malignancies, the standard response of physicians to the development of thrombocytopenia is dose reductions and/or delayed administration of the next cycle of chemotherapy (Table 2).
Other consequences of thrombocytopenia include the need for platelet transfusions and subsequent exposure to the risk of numerous complications, including bacterial and viral infections; febrile, nonhemolytic transfusion reactions; and transfusion-induced immunosuppression.
Low platelet counts are a frequent dose-limiting toxicity of chemotherapy regimens commonly used in the treatment of patients with solid tumors or lymphomas. Until the availability of rhIL-11 the standard response of physicians to low platelets has been dose reduction and delay of subsequent chemotherapy until adequate platelet recovery has been achieved. However, undue reduction in chemotherapy dose or lengthy interruption of planned treatment schedules can reduce antitumor efficacy and thus potentially jeopardize the achievement of optimal survival benefit or remission duration. Therefore, these management strategies are undesirable and should be avoided if possible. Although effective and used extensively to treat severe thrombocytopenia, platelet transfusions are complicated by a high frequency of adverse transfusion reactions and alloimmunization, leading to refractoriness to platelet transfusions as well as risk of infection (viral and bacterial).
Frequently, it is the major dose-limiting hematologic toxicity, especially in the treatment of potentially curable malignancies such as leukemia, lymphomas, and pediatric cancers.
The standard practice of reducing the dose of chemotherapeutic drugs and/or delaying treatment to avoid the risk of clinically significant bleeding secondary to thrombocytopenia could result in suboptimal outcome, including reduced antitumor efficacy and/or reduced survival rates or shorter duration of remission. [10,13,33-35]
However, the use of chemotherapy with or without radiation therapy is the most common cause of clinically significant thrombo-cytopenia. [1,2] The National Cancer Institute offers a grading system for determining the severity based on platelet counts (Table 1).