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Current Opinion in Hematology Jan 2016Neutropenia absolute neutrophil count (ANC) less than 1.5 × 10(9)/l is a common hematological finding, and severe neutropenia, that is, ANC less... (Review)
Review
PURPOSE OF REVIEW
Neutropenia absolute neutrophil count (ANC) less than 1.5 × 10(9)/l is a common hematological finding, and severe neutropenia, that is, ANC less than 0.5 × 10(9)/l is a well known risk factor for susceptibility to bacterial infections. This review provides a succinct clinical approach to the diagnosis and treatment of neutropenia with specific recommendations on the treatment of severe chronic neutropenia with the myeloid growth factor, granulocyte colony-stimulating factor (G-CSF).
RECENT FINDINGS
Experts agree that patients with acute febrile neutropenia should be treated with antibiotics and that patients at high risk of severe neutropenia (>20% risk) after myelosuppressive chemotherapy should be treated prophylactically with a myeloid growth factor, usually G-CSF. The diversity of causes and consequences of chronic neutropenia make the diagnosis and management of these patients more complicated.
SUMMARY
The review provides a stepwise approach to neutropenia focusing first on reaching a provisional diagnosis and treatment plan then steps to a final diagnosis. It also provides specific recommendations on the treatment of severe chronic neutropenia with G-CSF.
Topics: Humans; Neutropenia
PubMed: 26554885
DOI: 10.1097/MOH.0000000000000208 -
Anti-cancer Agents in Medicinal... 2021Doxorubicin (DOX) is widely used as a clinical first-line anti-cancer drug. However, its clinical application is severely limited due to the lack of tumor specificity of... (Review)
Review
Doxorubicin (DOX) is widely used as a clinical first-line anti-cancer drug. However, its clinical application is severely limited due to the lack of tumor specificity of the drug and severe side effects such as myelosuppression, nephrotoxicity, dose-dependent cardiotoxicity, and multi-drug resistance. To improve the bioavailability of DOX, maximize the therapeutic effect, and reduce its toxicity and side effects, many studies have been done on the nanoformulations of DOX, such as liposomes, polymer micelles, dendrimer, and nanogels. Herein, we review the latest progress of DOX nano-preparations and their anti-tumor effects, hoping to provide theoretical references and new research ideas for the development of new dosage forms of the drug and the technical methods available for clinical application.
Topics: Antibiotics, Antineoplastic; Cell Proliferation; Doxorubicin; Humans; Molecular Conformation; Nanoparticles; Neoplasms
PubMed: 33372884
DOI: 10.2174/1871520621666201229115612 -
Severe myelosuppression involving HPV-B19 infection and NUDT15 polymorphisms during therapy for LCH.Pediatrics International : Official... 2023
Topics: Humans; Papillomavirus Infections; Parvovirus B19, Human; Parvoviridae Infections; Polymorphism, Genetic
PubMed: 37888780
DOI: 10.1111/ped.15669 -
Experimental and Clinical... Oct 2021Renal transplant is considered the best therapeutic option for suitable patients with end-stage kidney failure. Hematological complications that occur after kidney... (Review)
Review
Renal transplant is considered the best therapeutic option for suitable patients with end-stage kidney failure. Hematological complications that occur after kidney transplant include posttransplant anemia, leukopenia, neutropenia, and thrombocytopenia. Severely persistent leukopenia and neutropenia events predispose patients to infection, including opportunistic infections. The mainstay tactic for such complications is to reduce the burden of the immunosuppression by the offending agent, but this tactic is associated with increased risk of acute rejection. Given the absence of laboratory investigations to specifically identify the culprit, a complete withdrawal of these agents may be the ultimate diagnostic option. Future therapeutic strategies, however, should focus on reducing the immunosuppressive burden, the introduction of less myelotoxic agents, early recognition, and prompt treatment of infectious episodes. This will help in the optimization of the myelopoietic function and normalization of the hematological profile, resulting in better allograft and patient survival.
Topics: Anemia; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Neutropenia; Treatment Outcome
PubMed: 33736582
DOI: 10.6002/ect.2020.0100 -
Cancer Management and Research 2020To investigate the potential factors to predict severe myelosuppression among low-risk gestational trophoblastic neoplasia (GTN) patients with single-agent methotrexate...
Factors Predicting Severe Myelosuppression and Its Influence on Fertility in Patients with Low-Risk Gestational Trophoblastic Neoplasia Receiving Single-Agent Methotrexate Chemotherapy.
PURPOSE
To investigate the potential factors to predict severe myelosuppression among low-risk gestational trophoblastic neoplasia (GTN) patients with single-agent methotrexate (MTX) chemotherapy. To analyze reproductive outcomes of patients with or without severe myelosuppression after achieving complete remission (CR).
PATIENTS AND METHODS
The retrospective study included 319 low-risk GTN patients registered from January 2008 to December 2018 in our hospital. Patients were divided into two groups according to myelosuppression grading. Their clinical data and reproductive outcomes were compared and analyzed.
RESULTS
A higher proportion of patients in group A received second-line chemotherapy than group B (<0.001). The number of total chemotherapy courses was more in group A than group B (=0.001), while the number of MTX chemotherapy courses was more in group B than group A (=0.001). When the joint predictor of pretreatment albumin (ALB) was not more than 44.5 g/L, pretreatment serum creatinine (Scr) was not less than 75.6 μmol/L, and the number of MTX chemotherapy courses was not less than four, there was a moderate predictive value. There was no significant difference of reproductive outcomes between the two groups after achieving CR.
CONCLUSION
Although some patients developed severe myelosuppression, MTX was still the effective first-line treatment for low-risk GTN patients. Patient's pretreatment ALB was not more than 44.5 g/L, pretreatment Scr was not less than 75.6 μmol/L, and the number of MTX chemotherapy courses not less than four could be used as combined predictors to recognize the risk of severe myelosuppression. Severe myelosuppression had no significant adverse influence on fertility after achieving CR.
PubMed: 32581584
DOI: 10.2147/CMAR.S252664 -
Gan To Kagaku Ryoho. Cancer &... Nov 2018A 57-year-old female patient received ileocecal colon resection because of colon cancer. Pathological findings showed pSSN2M0(pStage III b). After surgery, CapeOX was... (Review)
Review
A 57-year-old female patient received ileocecal colon resection because of colon cancer. Pathological findings showed pSSN2M0(pStage III b). After surgery, CapeOX was administered as an adjuvant chemotherapy. On day 13 of CapeOX treatment, severe oral mucositis and Grade 4 myelosuppression appeared, and the CapeOX treatment was immediately stopped. However, these adverse effects continued for 19 days, and she gradually recovered. The severe myelosuppression was caused bydeficiencyof DPD, which is a keyenzy me that metabolizes 5-FU. While DPD deficiencyis veryrare, we need to consider that 5-FU causes severe adverse events in patients with DPD deficiency.
Topics: Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Chemotherapy, Adjuvant; Colectomy; Colonic Neoplasms; Dihydropyrimidine Dehydrogenase Deficiency; Female; Humans; Middle Aged; Myeloid Cells; Oxaliplatin
PubMed: 30449859
DOI: No ID Found -
Journal of Clinical Virology : the... Aug 2002Cytomegalovirus (CMV) has long been associated with myelosuppression. Evidence for this association has been provided from in vitro studies, statistical analysis of... (Review)
Review
Cytomegalovirus (CMV) has long been associated with myelosuppression. Evidence for this association has been provided from in vitro studies, statistical analysis of clinical studies, informative case reports, and murine models. Reports differ as to how CMV mediates myelosuppression. Some data indicate direct infection of hematopoietic progenitors and their progeny, others indicate that the supportive microenvironment is infected and thereby its supportive function compromised. In this report we review data suggesting that the severity of myelosuppression in patients is associated with particular CMV genotypes identified by variations in the glycoprotein B gene.
Topics: Animals; Bone Marrow Cells; Cells, Cultured; Cytomegalovirus; Cytomegalovirus Infections; Female; Fibroblasts; Genetic Variation; Hematopoiesis; Hematopoietic Stem Cells; Humans; Mice; Stem Cell Transplantation; Viral Envelope Proteins
PubMed: 12361756
DOI: 10.1016/s1386-6532(02)00092-6 -
Scientific Reports Oct 2023This study aimed at establishing and validating a nomogram to predict the probability of severe myelosuppression in small cell lung cancer (SCLC) patients following the...
This study aimed at establishing and validating a nomogram to predict the probability of severe myelosuppression in small cell lung cancer (SCLC) patients following the first-line chemotherapy. A total of 179 SCLC cases were screened as the training group and another 124 patients were used for the validation group. Predictors were determined by the smallest Akaike's information criterion (AIC) in multivariate logistic regression analysis, leading to a new nomogram. The nomogram was validated in both training and validation groups and the predicting value was evaluated by area under the receiver operating characteristics (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA). Age and tumor staging were extracted as predictors to establish a nomogram, which displayed the AUC values as 0.725 and 0.727 in the training and validation groups, respectively. This nomogram exhibited acceptable calibration curves in the two groups and its prediction added more net benefits than the treat-all scheme and treat-none scheme if the range of threshold probability in the DCA was between 15 and 60% in the training and validation groups. Therefore, the nomogram objectively and accurately predict the occurrence of severe myelosuppression in SCLC patients following the first-line chemotherapy.
Topics: Humans; Nomograms; Small Cell Lung Carcinoma; Calibration; Patients; Lung Neoplasms
PubMed: 37838787
DOI: 10.1038/s41598-023-42725-7 -
Journal of Neuro-oncology Nov 2007Temozolomide is an alkylating agent used frequently in the management of gliomas. Although temozolomide is generally safe, rarely it can cause life threatening... (Review)
Review
Temozolomide is an alkylating agent used frequently in the management of gliomas. Although temozolomide is generally safe, rarely it can cause life threatening complications. Here we report the cases of two patients who developed prolonged and severe pancytopenia after low dose continuous temozolomide concurrently with cranial radiotherapy. The pancytopenia lasted two to six months. Both the patients were young, treatment naïve, and had temozolomide treatment for only approximately four weeks.
Topics: Antineoplastic Agents, Alkylating; Bone Marrow; Bone Marrow Diseases; Brain Neoplasms; Cranial Irradiation; Dacarbazine; Dose-Response Relationship, Drug; Female; Fever; Glioblastoma; Humans; Middle Aged; Neutropenia; Severity of Illness Index; Temozolomide; Treatment Outcome
PubMed: 17530175
DOI: 10.1007/s11060-007-9403-6 -
Journal of Ultrasound in Medicine :... Oct 2019This study aimed to investigate the effect of low-intensity pulsed ultrasound (LIPUS) on cyclophosphamide (CTX)-induced rabbit myelosuppression.
OBJECTIVE
This study aimed to investigate the effect of low-intensity pulsed ultrasound (LIPUS) on cyclophosphamide (CTX)-induced rabbit myelosuppression.
METHODS
Rabbits (n = 90) were randomly divided into a mild myelosuppression group (n = 40), a severe myelosuppression group (n = 40), and a normal control group (group Cu ; n = 10). The mild and severe myelosuppression models were established by daily ear vein injection of 15- and 40-mg/kg CTX for 4 continuous days, respectively. Then they were randomly divided into LIPUS groups (A and B ) and control groups (A and B ). LIPUS was applied once per day for 20 minutes for 7 (A and B ) and 28 (A and B ) days. Physical conditions, mortality, blood cell counts, and bone marrow proliferation were calculated. Erythropoietin interleukin 3, and granulocyte-macrophage colony-stimulating factor levels were measured by an enzyme-linked immunosorbent assay. Flow cytometry was used to detect the granulocyte phagocytosis rate. Hematoxylin-eosin staining was performed to analyze changes of skin and muscle.
RESULTS
Compared with the control group, LIPUS improved the number of peripheral blood cells (P < .05) and bone marrow nucleated cells and reduced the mortality of rabbits with myelosuppression of different degrees. Long-term treatment for 28 days had no effect on the levels of erythropoietin, interleukin 3, and granulocyte-macrophage colony-stimulating factor and granulocyte phagocytosis (P > .05). The parts of the skin where LIPUS was applied did not show any burning marks, and the muscle tissue in the path of LIPUS acoustic channels showed no obvious pathologic changes.
CONCLUSIONS
Low-intensity pulsed ultrasound is a safe and effective method to relieve CTX-induced myelosuppression.
Topics: Animals; Bone Marrow; Bone Marrow Diseases; Cyclophosphamide; Disease Models, Animal; Female; Male; Rabbits; Ultrasonic Therapy; Ultrasonic Waves
PubMed: 30835868
DOI: 10.1002/jum.14979