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Review | Open Access

Current management of chemotherapy-induced neutropenia in adults: key points and new challenges

Yi Ba1 ( ), Yuankai Shi2 ( ), Wenqi Jiang3, Jifeng Feng4, Ying Cheng5, Li Xiao6, Qingyuan Zhang7, Wensheng Qiu8, Binghe Xu2, Ruihua Xu3, Bo Shen4, Zhiguo Luo9, Xiaodong Xie10, Jianhua Chang9, Mengzhao Wang11, Yufu Li12, Yuerong Shuang13, Zuoxing Niu14, Bo Liu14, Jun Zhang15, Li Zhang3, Herui Yao16, Conghua Xie17, Huiqiang Huang2, Wangjun Liao18, Gongyan Chen7, Xiaotian Zhang19, Hanxiang An20, Yanhong Deng21, Ping Gong22, Jianping Xiong23, Qinghua Yao24, Xin An3, Cheng Chen4, Yanxia Shi3, Jialei Wang9, Xiaohua Wang4, Zhiqiang Wang3, Puyuan Xing2, Sheng Yang2, Chenfei Zhou15
Department of Gastrointestinal Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
Department of Oncology, Jilin Province Cancer Hospital, Changchun 130012, China
Department of Oncology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361004, China
Department of Oncology, Cancer Hospital Harbin Medical University, Harbin 150081, China
Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao 266003, China
Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Department of Oncology, General Hospital of Shenyang Military Region, Shenyang 110016, China
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
Lymphoma and Myeloma Department, Jiangxi Cancer Hospital, Nanchang 330029, China
Department of Medical Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430070, China
Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
Department of Medical Oncology, Xiang’an Hospital of Xiamen University, Xiamen 361101, China
Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi 832000, China
Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Science, Zhejiang Cancer Hospital, Hangzhou 310022, China
Show Author Information

Abstract

Chemotherapy-induced neutropenia (CIN) is a potentially fatal and common complication in myelosuppressive chemotherapy. The timing and grade of CIN may play prognostic and predictive roles in cancer therapy. CIN is associated with older age, poor functional and nutritional status, the presence of significant comorbidities, the type of cancer, previous chemotherapy cycles, the stage of the disease, specific chemotherapy regimens, and combined therapies. There are many key points and new challenges in the management of CIN in adults including: (1) Genetic risk factors to evaluate the patient’s risk for CIN remain unclear. However, these risk factors urgently need to be identified. (2) Febrile neutropenia (FN) remains one of the most common reasons for oncological emergency. No consensus nomogram for FN risk assessment has been established. (3) Different assessment tools [e.g., Multinational Association for Supportive Care in Cancer (MASCC), the Clinical Index of Stable Febrile Neutropenia (CISNE) score model, and other tools] have been suggested to help stratify the risk of complications in patients with FN. However, current tools have limitations. The CISNE score model is useful to support decision-making, especially for patients with stable FN. (4) There are still some challenges, including the benefits of granulocyte colony stimulating factor treatment and the optimal antibiotic regimen in emergency management of FN. In view of the current reports, our group discusses the key points, new challenges, and management of CIN.

Keywords

cancerChemotherapy-induced neutropenia (CIN)febrile neutropeniarisk stratificationgranulocyte-colony stimulating factor (G-CSF)

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Cancer Biology & Medicine
Volume 17 Issue 4,
November 2020
Pages 896-909
DOI: 10.20892/j.issn.2095-3941.2020.0069
Cite this article:
Ba Y, Shi Y, Jiang W, et al. Current management of chemotherapy-induced neutropenia in adults: key points and new challenges. Cancer Biology & Medicine, 2020, 17(4): 896-909. https://doi.org/10.20892/j.issn.2095-3941.2020.0069

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Received: 22 February 2020
Accepted: 23 July 2020
Published: 15 November 2020
©2020 Cancer Biology & Medicine.

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