Myelosuppression chemotherapy-related

The National Comprehensive Cancer Network (NCCN) recommends an anemia work-up for patients with hemoglobin of less than 11 g/dL (110 g/L or 6.8 mmol/L). Patients who are symptomatic or asymptomatic with significant risk factors (e.g., extensive transfusion history, myelosuppressive chemotherapy, etc) may qualify for treatment with erythropoietic agents such as epoetin-alfa or darbepoetin. Data do not support the use of one agent over another they are both equally effective in treating this type of anemia.12 Table 63-4 provides dosing recommendations for chemotherapy-related anemia. 

Overall survival is affected by the success of the initial surgery to debulk the tumor to less than 1 cm of disease and response to first-line chemotherapy. The CA-125 level should be monitored with each cycle, and at least a 50% reduction in CA-125 after four cycles of taxane/platinum chemotherapy is related to an improved prognosis. Patients who achieve a complete response should have follow-up examinations every 3 months, including CA-125 determination, physical examination, pelvic examination, and appropriate diagnostic scans (e.g., CT scan, MRI, or PET scan) and should be evaluated for the detection of disease. Evaluate patients for resolution of any residual chemotherapy-related side effects, including neuropathies, nephrotoxicity, ototoxicity, myelosuppression, and nausea/vomiting. 

G. Other applications Leukine has been effective in producing increases in normally functioning neutrophils, eosinophils, and monocytes in AIDS patients and patients with leukopenia. Leukine may prolong survival when used as adjuvant therapy in patients with stage III or IV malignant melanoma. Leukine has also been effective in abrogating chemotherapy-related neutropenia in cancer patients, with a reduction in the severity and duration of chemotherapy-induced myelosuppression. 

Although the extent of leukopenia is not related to cumulative anthracycline dose, patients who have received extensive prior chemotherapy develop more severe leukopenia, possibly because of diminished bone marrow reserve (24). There was a strong correlation between dose and both leukocyte nadirs and platelet nadirs in 287 patients who received single-agent epirubicin 40, 60, 90, or 135 mg/m every 3 weeks (56). Myelosuppression correlates with exposure to epirubicin, as reflected by the plasma AUC (57). 

Carboplatin is a cytotoxic platinium complex structurally related to cisplatin, which antitumor activity in vitro is qualitatively similar to that of cisplatin. Comparative trials with carboplatin alone or in combination with other chemotherapeutic agents suggest comparable efficacy with cisplatin in ovarian cancer. As with cisplatin, nausea and vomiting occur in many patients but symptoms are usually delayed for several hours and mild to moderate in severity. The dose limiting toxicity of carboplatin is myelosuppression enhanced by renal impairment, previous chemotherapy or in older patients. 

The treatment of patients with AIDS-associated lymphomas is difficult because the immunocompromised state of these patients increases their risk of significant toxicity due to myelosuppressive therapy. Except for primary CNS lymphoma, AIDS-related lymphoma is never considered truly localized, and systemic chemotherapy is indicated. For patients with adequate immune function and without a history of an opportunistic infection, chemotherapy regimens similar to those used for aggressive lymphomas may be used. " However, many patients with AIDS-related lymphoma are treated with less intensive regimens because of the increased risk of treatment-related toxicity. In the era of highly active antiretroviral therapy (HAART), however, some clinicians believe that standard doses of chemotherapy can be safely administered to patients who achieve a virologic response to HAART. 

AML accounts for most cases of acute leukemia in adults, and occurs with increasing frequency in elderly patients. It accounts for only 15% to 20% of the acute leukemias in children, but is responsible for 30% of leukemia-related mortality. With recent advances in chemotherapy and supportive care, 65% to 85% of all patients achieve CR and 20% to 40% become long-term survivors. " Overall, the median duration of remission is 1 to 2 years. " In patients older than age 60 years, the percentage of patients achieving a CR is lower (39% to 64%), and the median duration of remission is shorter than 1 year. In contrast to ALL, effective therapies used in AML cause severe and often prolonged myelosuppression, with the exception of tretinoin. As a result, patients with AML, particularly patients older than age 60 years, are at greater risk for treatment-related fatal infectious and bleeding complications. 

A related anthracenedione, mitoxantrone, has been approved for use in AML. Mitoxantrone has limited ability to produce quinone-type free radicals and causes less cardiac toxicity than does doxorubicin. It produces acute myelosuppression, cardiac toxicity, and mucositis as its major toxicities the drug causes less nausea and vomiting and alopecia than does doxorubicin. It is also used as a component of experimental high-dose chemotherapy regimens, with uncertain efficacy. 

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