May 30, 2024

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Why does Bone marrow suppression (Myelosuppression) commonly occur after chemotherapy?

Why does Bone marrow suppression (Myelosuppression) commonly occur after chemotherapy?


Why does Bone marrow suppression (Myelosuppression) commonly occur after chemotherapy?

Bone marrow suppression (Myelosuppression) is a common side effect during chemotherapy, and the use of white blood cell booster injections is a common method to counteract this suppression.

But what exactly is bone marrow suppression and what does it suppress? Do all patients need white blood cell booster injections?


Why does Bone marrow suppression (Myelosuppression) commonly occur after chemotherapy?



What is bone marrow suppression?


Chemotherapy is an important treatment for cancer, and since it involves the use of cytotoxic drugs, it can inhibit rapidly dividing cells.

Bone marrow is the body’s hematopoietic tissue, where cells proliferate rapidly to produce blood cells. Therefore, chemotherapy can interfere with the bone marrow’s ability to produce blood cells, resulting in bone marrow suppression.


Unfortunately, chemotherapy not only kills white blood cells but also affects the replenishment of these cells.

If the white blood cell count drops to a critical level, doctors often have to reduce the chemotherapy dosage or delay treatment.

This, in turn, significantly reduces the effectiveness of chemotherapy and may even lead to treatment interruption, eventually causing tumor recurrence or metastasis.


What does bone marrow suppression suppress?


Most commonly, bone marrow suppression leads to a decrease in white blood cells, followed by a decrease in platelets. The reduction in white blood cells is usually more severe than that of platelets, and in some cases, severe anemia may occur, leading to bone marrow failure. Several chemotherapy drugs can cause bone marrow suppression, such as docetaxel, among others.


Bone marrow suppression primarily affects neutrophils (a type of white blood cell) as they have the shortest survival time of 6 to 8 hours. Hence, the first signs of bone marrow suppression usually manifest as a decrease in neutrophil count, as they are most affected by chemotherapy.

Platelets have a survival time of 5 to 7 days, and their decrease occurs later and is relatively mild. Red blood cells have a much longer survival time of 120 days and are less affected by chemotherapy, so their decline is generally not significant.


Most chemotherapy drugs can cause varying degrees of bone marrow suppression, with a more pronounced decrease in platelet levels.

After chemotherapy, treatment is often spaced out to allow time for bone marrow cell recovery. Many chemotherapy cycles are scheduled every 3 to 4 weeks for this purpose.


Classification and Grading of Bone Marrow Suppression


Bone marrow suppression commonly occurs after chemotherapy. Since neutrophils have the shortest average lifespan of approximately 6-8 hours, bone marrow suppression typically manifests first as a decline in white blood cells.

Platelets have an average lifespan of about 5-7 days, and their decline occurs later and is relatively mild, but some chemotherapy drugs primarily cause bone marrow suppression with decreased platelet counts.

Red blood cells have an average lifespan of 120 days and are less affected by chemotherapy, so their decline is usually not significant, but it may be indicated by a progressive decrease in hemoglobin levels.

Most chemotherapy-induced bone marrow suppression is usually observed 1-3 weeks after chemotherapy and lasts for about 2-4 weeks before gradually recovering, with a primary decline in white blood cells and potential accompanying platelet decline.


When patients undergo chemotherapy, a reduction in blood cell count occurs. Though there are numerous indicators in a complete blood count (CBC), for cancer patients undergoing chemotherapy, it’s essential to focus on key indicators in the laboratory results (white blood cells [WBC], neutrophils [NEUT], hemoglobin [HGB], and platelets [PLT]). The following table summarizes the grading of bone marrow suppression.

When Grade III-IV adverse reactions occur, they require heightened attention.



Clinical Manifestations of Bone Marrow Suppression


  • In mild bone marrow suppression, patients may not exhibit significant clinical symptoms, but some might experience feelings of fatigue or tiredness. This phase presents the optimal time for treatment.
  • Severe bone marrow suppression may also be asymptomatic. However, if not promptly detected and corrected, patients may experience signs of infection such as fever, sore throat, cough, diarrhea, frequent urination, and painful urination, indicating a decrease in white blood cells (WBC) and neutrophils (NEUT). Gradual onset of symptoms like palpitations, shortness of breath, and pale complexion may suggest a decrease in hemoglobin (HGB) levels. Appearance of skin discoloration (“bruising”), gum bleeding, nosebleeds, coughing up blood, vomiting blood, or blood in the stool may indicate a decline in platelets (PLT). Some patients may not feel particularly uncomfortable after chemotherapy and assume that bone marrow suppression did not occur. However, this assumption is incorrect, as bone marrow suppression may not always present with noticeable symptoms, highlighting the importance of regular CBC testing.
  • Severe bone marrow suppression can lead to complications such as extremely low immunity and coagulation disorders, causing life-threatening complications like severe infections and significant organ bleeding.



Why should white blood cell decline not be left unattended?


Although bone marrow suppression is temporary, the consequences can be severe if complications occur, such as severe infections or life-threatening organ bleeding.


We all know that white blood cells are the “guardians” of the body in the fight against diseases. A decrease in white blood cells directly affects the body’s immune system, leading to reduced immunity and increased susceptibility to infections.

The longer the duration of neutrophil deficiency, the greater the risk of infection. A decrease in red blood cells can result in anemia and fatigue. If platelets are reduced, the clotting mechanism is impaired, leading to bleeding symptoms. Therefore, cancer patients undergoing treatment, especially those with low platelet counts, should avoid vigorous exercise to prevent bleeding.


To complete the planned course of chemotherapy successfully while ensuring its effectiveness, cancer patients often require other means to boost white blood cell levels during chemotherapy, such as using white blood cell booster injections.


Methods commonly used by doctors to treat bone marrow suppression: 

When bone marrow suppression occurs, it is essential to promptly treat the condition, a process known as correcting bone marrow suppression.

Please note: The treatment herein just for reference, should not be taken or understood as advice of any nature, consulting relevant professionals is a must.

1. Neutrophil (white blood cell – WBC, and neutrophil – NEUT) bone marrow suppression:

The commonly used treatment is recombinant human granulocyte colony-stimulating factor (G-CSF), available in both short-acting and long-acting forms.

Short-acting G-CSF is recommended for continuous use for 3-5 days until the NEUT absolute value reaches above 10×10^9/L, after which the medication is stopped.

Long-acting drugs are more convenient, requiring only one administration per treatment cycle to boost blood levels.

However, the effectiveness of G-CSF may vary among different patients, and it may not always correct bone marrow suppression. Regular blood tests should still be conducted to monitor changes in blood counts.


Possible misconceptions during treatment include some patients discontinuing short-acting G-CSF after only 1-2 days, which may not effectively mobilize the bone marrow.

Additionally, some patients, upon seeing low white blood cell counts in their blood tests, receive a short-acting G-CSF injection on the day of admission, creating a false impression of “normal blood counts.”

It’s important to understand that such “blood boosting” may lead to more severe bone marrow suppression after the next chemotherapy cycle.


2. Platelet (PLT) reduction:

Interleukin-11 (IL-11) or recombinant human thrombopoietin (TPO) can be used to correct bone marrow suppression when platelet levels are low.

Usually, continuous administration for 5-7 days is required before significant effects are seen.

Treatment can be stopped when platelet counts exceed 100×10^9/L.

Since the medication’s effects may take some time, close monitoring of blood counts is necessary during the process, and if needed, external platelet transfusions may be given to prevent the risk of bleeding.


3. Hemoglobin (HGB) reduction:

This is commonly known as anemia. Cancer patients are often prone to anemia, and chemotherapy-induced reduction in HGB levels typically occurs after multiple chemotherapy sessions.

This can be corrected by using recombinant human erythropoietin (EPO) or oral medications.

It’s essential to assess if the patient’s serum iron and transferrin levels are low and promptly supplement them with hematopoietic materials such as iron agents, folic acid, and vitamins. In necessary cases, blood transfusions may also be administered.




Do all patients need white blood cell booster injections?


In clinical practice, Western medicine often uses white blood cell booster injections to elevate white blood cell levels. However, not all patients require these injections.

If the decrease in white blood cells is not significant, the white blood cell count may gradually recover within 2 to 4 weeks.

Doctors will assess the patient’s condition and the extent of bone marrow suppression after chemotherapy to determine whether white blood cell booster injections are necessary.


White blood cell booster injections can rapidly increase the number of white blood cells, acting as a “ripening agent” that promotes the rapid maturation of “immature” neutrophils in the bone marrow, releasing them into the peripheral blood.

While this can swiftly elevate white blood cell counts, it is only a temporary measure and should not be repeatedly used to avoid excessive fatigue of the white blood cells. This is why some patients may experience significant improvement after using white blood cell booster injections in the initial treatments, but later on, the effects may not be as noticeable.


Additionally, many patients have reported experiencing bone pain after receiving white blood cell booster injections, and some still experience a decrease in white blood cell count even after receiving these injections. So, besides using white blood cell booster injections, are there any other methods to increase white blood cell levels?


Dietary Nutrition for Patients with Low White Blood Cell Count


Patients with low white blood cell count should increase the intake of foods rich in high-quality proteins, such as eggs, lean meats, dairy products, and soy-based dishes, while maintaining a balanced diet. This provides the necessary building blocks for the regeneration of white blood cells.

It is also advisable to consume a moderate amount of fresh fruits and vegetables that are rich in antioxidant nutrients to balance the excess of free radicals in the body and reduce the side effects of chemotherapy.

However, it is not recommended to follow any unverified dietary remedies, such as consuming large amounts of pork trotter soup or herbal concoctions, to avoid nutritional deficiencies caused by improper diet.


For patients who are malnourished, it is recommended to supplement their nutrition appropriately under the guidance of their primary physician or clinical nutritionist and adjust their diet according to changes in their condition.

Patients with low white blood cell count should pay special attention to food hygiene and avoid infections. It is best to avoid crowded places whenever possible and wear a mask when going outside.


In addition, patients undergoing high-dose chemotherapy (stem cell transplantation) should pay extra attention to their dietary nutrition.

If there is a lack of appetite or difficulties in eating, nutritional support methods, such as enteral and parenteral nutrition, can be used under the guidance of the primary physician or clinical nutritionist to provide adequate nourishment.


Throughout the entire high-dose chemotherapy period, the patient’s diet should be light, soft, and easily digestible, avoiding sticky, coarse, spicy, overly sweet, and greasy foods. Paying attention to proper nutritional balance is also important.


Food Hygiene for Patients with Low White Blood Cell Count


High-dose chemotherapy drugs not only harm tumor cells but can also damage healthy cells, especially those with rapid proliferation, such as bone marrow cells, hair follicle cells, and gastrointestinal epithelial cells.

This can easily lead to a significant decrease in white blood cells, even dropping to zero, making the body vulnerable to bacterial infections.

Therefore, during this period, it is essential to be particularly attentive to dietary hygiene and food choices. Ensuring sufficient nutrient intake is crucial to providing the raw materials needed for the regeneration of white blood cells.


At the end

Chemotherapy requires experienced physicians to develop appropriate treatment plans.

Throughout the chemotherapy process, close monitoring of adverse reactions is essential.

Patients should be informed about monitoring their blood routine and being attentive to other chemotherapy-related symptoms upon discharge.

After leaving the hospital, patients need to regularly monitor their blood routine and promptly communicate any discomfort or side effects experienced after chemotherapy with their primary physician.

Only through the collaborative efforts of both medical professionals and patients in detecting and managing bone marrow suppression can chemotherapy be successfully completed according to the planned schedule.



(source:internet, reference only)

Disclaimer of

Important Note: The information provided is for informational purposes only and should not be considered as medical advice.