Preventing neutropenia - so that your cancer treatment goes according to plan

  • For chemotherapy according to plan

In addition to inhibiting the growth of cancer cells, cancer treatment drugs can also affect the function of the bone marrow. Consequently, this may impair blood cell formation. If neutrophil granulocytes, which are important for the immune response, are affected, this is called neutropenia. Neutropenia can lead to increased susceptibility to infection and interfere with the timely implementation of cancer treatment.

Read here about the potential impact of neutropenia on cancer treatment and how to prevent this side effect.

You can find more detailed information in the section for specialist groups.

Neutropenia during cancer therapy

Neutropenia during cancer therapy

Why does neutropenia occur?

Drugs that inhibit cell division can also inhibit the division of stem and progenitor cells in the bone marrow. This is called myelosuppression, and it leads to a reduced production of blood cells. There may be a reduction in the number of white or red blood cells (leucocytes or erythrocytes) or platelets (thrombocytes) in the blood.

Chemotherapy primarily suppresses the production of white blood cells (leukocytes), and particularly a specific subtype called neutrophil granulocytes (neutrophils for short). In that case, one then speaks of

Chemotherapy-induced neutropenia

[Translate to English:] Bloodcell

What does this mean for patients?

The risk of infection increases if the number of neutrophil granulocytes falls sharply. Even a slight decrease in neutrophil granulocytes can increase susceptibility to infection. Neutropenia can be life-threatening if it is accompanied by a significantly raised body temperature due to an existing infection (febrile neutropenia).

Almost all patients with febrile neutropenia have to be hospitalised.

In such cases, a broad-spectrum antibiotic is used until the specific pathogen is identified or the neutrophil count has recovered and the fever has subsided.

Even with less severe neutropenia, the consulting doctors may need to delay cancer treatment or reduce the dose.

Blood values are therefore checked regularly if there is a risk of neutropenia due to the chosen cancer treatment. Preventive supportive medication can be used to prevent neutropenia from occurring in the first place.

Preventing neutropenia

Detailed information on neutropenia can be found in our section for specialist groups:

To the login for specialist groups

Chemotherapy-induced neutropenia (CIN)

Chemotherapy-induced neutropenia (CIN)

Chemotherapy carries a risk of patients developing chemotherapy-induced neutropenia (CIN). The risk depends on how much the chemotherapy damages the bone marrow.

When does chemotherapy lead to CIN?

Highly effective chemotherapy combinations, which are used when the cancer in question can be cured, are particularly likely to cause neutropenia. Personal risk factors can also increase the risk of neutropenia. Consulting doctors can assess the risk on the basis of treatment guidelines, study data and individual information, for example on concomitant diseases.

How does neutropenia affect chemotherapy?

If neutropenia is detected during chemotherapy, the cancer treatment often cannot be carried out as planned.

  • Reducing or delaying the dose
    Due to neutropenia, consulting doctors may be forced to reduce the dose of chemotherapy or delay the time of administration. Chemotherapy can only be resumed as planned when the neutrophil count has recovered sufficiently.
  • Importance for treatment success
    If chemotherapy is administered in lower doses or at longer intervals than planned, this can have a negative impact on disease control. To ensure that chemotherapy can be administered as planned, supportive medication may be given to minimise the occurrence of neutropenia.

Preventing neutropenia

Preventing neutropenia

Preventing neutropenia

Substances that upregulate the neutrophil granulocyte count in the blood have been used since the 1990s to prevent chemotherapy-induced neutropenia. Until now, the main difference between available active ingredients has been their duration of action. Now, for the first time, active ingredients with a new molecular structure are available.

Granulocyte colony-stimulating factor (G-CSF)

Granulocyte colony-stimulating factor is a hormone that is released by the body as a growth factor, for example during inflammation, and that stimulates the production of granulocytes. This effect is used therapeutically to stimulate the production with molecular biologically produced G-CSF during chemotherapy, thereby reducing the duration of neutropenia and the frequency of febrile neutropenia in cancer patients.

CIN prophylaxis with G-CSF

Biotechnologically produced recombinant G-CSF is used to prevent chemotherapy-induced neutropenia. A distinction is made between short-acting G-CSF, which requires daily administration, and long-acting G-CSF, which is required only once per chemotherapy cycle.

Today, long-acting G-CSF is usually used for outpatient chemotherapy. Until now, longer efficacy was achieved by coupling the G-CSF molecule to polyethylene glycol (PEG). The risk of hypersensitivity reactions and loss of efficacy of so-called pegylated drugs increases because the increasing use of PEG, e.g., in cleaning agents and vaccines, has greatly increased the prevalence of antibodies against PEG in the population. There is therefore an increasing demand for PEG-free substances.

Newly developed G-CSF, which achieve long-lasting efficacy without PEGylation thanks to a new molecular structure, can meet this need for CIN prophylaxis.

Further information on CIN prophylaxis with G-CSF can be found in our section for specialist groups:

Downloads

Downloads

Sources

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