Othieno-Abinya NA, Waweru A, Nyabola LO. Chemotherapy induced myelosuppression.

"Othieno-Abinya NA, Waweru A, Nyabola LO. Chemotherapy induced myelosuppression." East Afr Med J. . 2007;84(1):8-15.


OBJECTIVE: To evaluate chemotherapy induced myelosuppression, its management and
DESIGN: Retrospective analysis of patients aged 13 years and above.
SETTING: Hurlingham Oncology Clinic and the Nairobi Hospital during the period of
June 1998 to June 2003.
SUBJECTS: Two hundred and two solid tumour and lymphoma patients treated with
pulsed chemotherapy at Hurlingham Oncology Clinic and those treated by the same
service at the Nairobi Hospital.
RESULTS: Two hundred patients were evaluable for nadir blood counts. World Health
Organisation (WHO) grade 3 neutropaenia complicated 57 (26.1%), and grade 4
complicated 56 (25.7%) treatments. Grade 0 neutropaenia was seen in 40 (18.4%)
treatments, 33 having included prophylactic Granulocyte-Colony Stimulating
Factors (G-CSF). Neutropaenia was worst following the first and sixth courses,
and repeated second line courses but the difference was not statistically
significant (p = 0.154). Fever complicated 6 grade 3 and 21 grade 4 neutropenic
episodes (23.1% of 117 evaluable). Twenty eight patients were hospitalised
because of severe neutropaenia (23 febrile, and five afebrile initially but with
absolute neutrophil counts < 0.01 x 10(9)/litre). Eight of them died, six
attributable to infections (21.4% mortality) and two attributed to other causes.
Median time to neutrophil recovery to 21.5 x 10(9)/litre was three days with a
mean of 4.6 days. Anaemia and thrombocytopaenia were not commonly experienced.
CONCLUSION: Prophylactic use of G-CSF may have prevented severe neutropaenia and
its use in severe neutropaenia may have reduced the duration and severity of
neutropaenia but the mortality rate for febrile neutropaenia remained high.

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