Myelosuppression
Myelosuppression is a condition characterized by decreased bone marrow function, leading to lower than normal levels of red blood cells, white blood cells, and platelets. This reduction can result in various related health issues, including anemia, neutropenia, leukopenia, and thrombocytopenia. The condition often arises during cancer treatments, particularly those involving chemotherapy or radiation therapy, which damage not only cancer cells but also hematopoietic stem cells in the bone marrow. Myelosuppression may also be linked to blood cancers, such as leukemia and lymphoma, as well as certain viral infections.
Symptoms vary based on which blood cell type is affected and can include fatigue, increased susceptibility to infections, and easy bruising or bleeding. Diagnosis typically involves blood tests and, in some cases, bone marrow biopsies. Treatment strategies focus on addressing the specific type of cell line affected and may involve adjusting chemotherapy regimens, administering transfusions, or providing growth factors to stimulate blood cell production. If left untreated, myelosuppression can significantly impact a patient's quality of life and increase the risk of complications like infections and bleeding. Preventive measures, including vaccinations and good hygiene practices, can help mitigate the risk of myelosuppression, particularly when associated with viral infections.
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Myelosuppression
ALSO KNOWN AS: Bone-marrow suppression, pancytopenia, myelotoxicity
RELATED CONDITIONS: Anemia, neutropenia, leukopenia, thrombocytopenia, pancytopenia
DEFINITION: Myelosuppression is a condition in which bone marrow function is decreased, with fewer than normal numbers of red blood cells, white blood cells, and platelets. Complete loss of bone marrow function is called myeloablation.
Risk factors: Risk factors include having had chemotherapy, radiation therapy, bone marrow or stem cell transplants, and myelodysplastic syndromes. The most common myelosuppression-causing therapies include fluorouracil, oxaliplatin, irinotecan, CAR T-cell therapy, and capecitabine. Some blood cancers, like leukemia and lymphoma, may also cause myelosuppression. Viruses like Epstein-Barr virus (EBV), hepatitis C, Human immunodeficiency virus (HIV), and chickenpox are linked to myelosuppression.
Etiology and the disease process: and radiation therapy for cancer destroy the rapidly dividing cancer cells as well as other rapidly dividing cells, or hematopoietic stem cells. As with anemia, leukopenia, and thrombocytopenia, hematopoietic stem cells are damaged by drugs used in chemotherapy or radiation therapy. Cell counts often return to baseline values when treatment is stopped, reduced, or delayed.
Incidence: While receiving cancer treatment, many patients experience some level of myelosuppression.
Symptoms: Depending on which cell line is involved, patients may feel weak, short of breath, and tired (anemia), be susceptible to infections and have fevers (leukopenia), or bruise and bleed easily (thrombocytopenia).
Screening and diagnosis: For routine monitoring during cancer therapy, myelosuppression is generally measured through blood tests—complete blood count, mean corpuscular volume, red cell distribution width, reticulocyte count, and mean platelet volume. Sometimes, aspiration or core needle biopsy of the bone marrow aids in diagnosing leukemia, lymphomas, and multiple myelomas, diseases associated with severe myelosuppression.
Treatment and therapy: Treatment for myelosuppression depends on which cell line is involved. Stopping or reducing the amount of chemotherapeutic drugs or radiation therapy given may relieve the myelosuppression. Anemia may be treated with red blood cell transfusions, steroids, supplements, or erythropoiesis-stimulating proteins such as epoetin alfa (Procrit, Epogen) or darbepoetin alfa (Aranesp). Leukopenia treatments include hematopoietic growth factors such as filgrastim (Neupogen), pegfilgrastim (Neulasta), and sargramostim (Leukine). Thrombocytopenia may be treated with platelet transfusions or a recombinant form of interleukin (oprelvekin or Neumega).
Prognosis, prevention, and outcomes: Left untreated, myelosuppression can impair a patient’s quality of life, increase the need for hospitalization and transfusions of red blood cells or platelets or both, increase the need for intravenous anti-infectives, and increase the risk of bleeding and infections. The use of hematopoietic, erythropoietic, and thrombocyte growth factors and transfusions is routine in supportive cancer treatment. Additionally, staying current on vaccines and practicing good hygiene can prevent virus-induced myelosuppression. Adults with small cell lung cancer can receive a Trilaciclib (COSELA) injection to help prevent myelosuppression.
Bibliography
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Crawford, Jeffrey, et al. "The Impact of Myelosuppression on Quality of Life of Patients Treated with Chemotherapy." Future Oncology, 2024. doi.org/10.2217/fon-2023-0513.
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Hart, Lowell. "Burden Of Chemotherapy-Induced Myelosuppression among Patients with Extensive-Stage Small Cell Lung Cancer: A Retrospective Study from Community Oncology Practices." Cancer Medicine, vol. 12, no. 8, Apr. 2023, pp. 10020-10030. doi.org/10.1002/cam4.5738.
"Myelosuppression (Bone Marrow Suppression)." Cleveland Clinic, 27 Feb. 2023, my.clevelandclinic.org/health/diseases/24788-myelosuppression. Accessed 20 June 2024.