ecancermedicalscience

Research

The occurrence and risk factors of chemotherapy-induced neutropenia in patients with breast cancer not receiving primary G-CSF prophylaxis

2 Nov 2023
Susanna Hilda Hutajulu, Siswi Oktariani, Agus Jati Sunggoro, Bagas Suryo Bintoro, Yufi Kartika Astari, Juan Adrian Wiranata, Irianiwati Widodo, Anita Ekowati, Mardiah Suci Hardianti, Kartika Widayati Taroeno-Hariadi, Johan Kurnianda, Ibnu Purwanto

Background: Chemotherapy-induced neutropenia (CIN) is a substantial side effect in chemotherapy of breast cancer patients. Administration of granulocyte colony stimulating factor (G-CSF) that may reduce CIN occurrence is not commonly available to many local cases.

Objectives: To investigate the occurrence of grade 4 CIN and the influencing factors in breast cancer patients not receiving G-CSF prophylaxis.

Methods: One-hundred and eighty-six newly diagnosed breast cancer patients who received a 3-weekly (neo)adjuvant or palliative chemotherapy without primary G-CSF prophylaxis were included. Grade 4 CIN was defined as absolute neutrophil count (ANC) <0.5 × 103/mm3 during any chemotherapy cycle. We used logistic regression to explore the association of clinical, pathological and treatment factors with the risk of grade 4 CIN in the first cycle and in any given cycle.

Results: Fifty-seven (30.6%) patients experienced grade 4 CIN in the first cycle and 145 (78%) had it at least once during chemotherapy. In the first cycle, haemoglobin, ANC, and albumin levels were associated with grade 4 CIN (OR = 1.48, p = 0.031; OR = 0.68, p = 0.006; and OR = 2.07, p = 0.042). In any cycle, pre-treatment ANC levels and anthracycline-taxane combination regimen were associated with grade 4 CIN (OR = 0.78, p = 0.032 and OR = 3.64, p = 0.012).

Conclusions: A significant proportion of the local breast cancer cases undergoing chemotherapy without primary G-CSF prophylaxis experienced grade 4 CIN. Haemoglobin, ANC, and albumin levels are the risk factors for first cycle CIN, while pre-treatment ANC levels and anthracycline-taxane chemotherapy regimen are associated with CIN in any given cycle. These risk factors may be used to direct a recommendation of G-CSF prophylaxis to the most at-risk individuals in the local setting or other settings in similar situations.

Related Articles

Fatima Shaukat, Tayyab Siddiqui, Yumna Ahmed, Muneeba Khan, Mariam Fahim, Asna Noor, Agha Muhammad Hammad Khan, Ahmed Nadeem Abbasi
Nicolás Duque Clavijo, Juana Catalina Figueroa Aguirre, Claudia del Pilar Agudelo Lopez, Andrés Armando Borda, Beatriz Wills, Guillermo Enrique Quintero Vega
Innocent Atuhe, Alfred Jatho, Babra Nalwadda, Judith Asasira, Martha Nantayi, Joseph Semujju, Naome Namwira, Kulusum Namayanja, Ashley Atwine, Semei Buwambaza Sekitene, , Jackson Orem