In an interview with The American Journal of Managed Care®, Kashyap Patel, MD, Carolina Blood and Cancer Care, discussed risk factors that contribute to the development of neutropenia, how to minimize the risk of development, the effects of neutropenia, and what he recommends to patients who have been treated for the condition.
Neutropenia is characterized by an abnormally low count of neutrophils, a type of white blood cell, often resulting from chemotherapy. In an interview with The American Journal of Managed Care®, Kashyap Patel, MD, Carolina Blood and Cancer Care, discussed risk factors that contribute to the development of neutropenia, how to minimize the risk of development, the effects of neutropenia, and what he recommends to patients who have been treated for the condition.
Risk factors that can lead to the development of neutropenia
There are a number of risk factors for developing neutropenia, said Patel. Chemotherapy can be divided into 3 groups according to myelotoxicity, a measure of the toxicity to myeloid cells such as neutrophils, which causes neutropenia. These groups are highly myelotoxic, moderately myelotoxic, and mildly myelotoxic. While any regimen can cause neutropenia, regimens that are not highly myelotoxic are not as likely to.
Moderate and mild myelotoxic chemotherapy can cause neutropenia in patients with multiple comorbidities or patients who have had previous chemotherapy/radiation treatment. These patients are also more vulnerable to rapid complications of neutropenic sepsis. Lastly, low protein levels reflect an element of malnutrition and a catabolic process that makes the immune system weaker than in the normal person.
Minimizing the risk
Patients undergoing traditional or conventional chemotherapy can be administered 2 granulocyte-colony stimulating factors to minimize the risk of developing neutropenia: filgrastim or pegfilgrastim. Filgrastim is a short-acting formulation and is used once daily for 14 days. Pegfilgrastim is a long-acting formulation and is administered once per chemotherapy cycle, about every 2 or 3 weeks.
Traditional and conventional therapies come with the risk of neutropenia because they are a non-specific group of drugs, so they work by attacking every cell, whether they are abnormal or normal. From this, we see the neutropenia side effect as collateral damage, said Patel. New cancer treatments such as immunotherapy have a much lower risk of producing neutropenia as a side effect because they only target cells that carry the specific mutation or signal. They are more specific, so they are less likely to affect the normal blood cells or normal body cells.
Treating for neutropenia
If a patient is diagnosed with neutropenia, there are effects that come with it, explain Patel. The function of white blood cells is to prevent against infections, and neutropenia is an abnormally low count of white blood cells. The main effect of this is that patients with neutropenia are at risk for life threatening infections because their body does not have its defense system.
Once treated for neutropenia, Patel has several recommendations for patients. They must be cautious of any low-grade fevers, a sign of febrile neutropenia. If they are undergoing chemotherapy and are neutropenic, they are at high risk for sepsis. He also recommends staying away from crowded places such as the church or the mall because they are more susceptible to catching an infection and are not able to fight against it.