Nadir peripheral blood cell counts in patients on treatment for non-hodgkin's lymphoma and breast cancer with cyclophosphamide, doxorubicin, vincristine and predinsone (CHOP) and doxorubicine & cyclophosphmide (AC) respectively

Abstract

Poor hematological status and development of sepsis due to temporary bone marrow failure are major contributing factors to treatment schedule interruptions and hence poor outcome in our set up. With this in mind, we set out in this study to find out, the effects of treatment using CHOP for NHL and AC for breast cancer on the peripheral blood cells of our patients. Objectives; To determine the complete blood counts on day ten to fourteen of the first two cycles and day twenty one of the first cycle, and subsequently to determine the peripheral blood nadirs on day ten to fourteen of the two cycles. Design and Setting: A prospective descriptive study using a real life usual practice scenario at Kenyatta National Hospital. Results: Following the administration of the first cycle of chemotherapy on day 10 to 14, the median WBC reached a nadir that was 45% and 40% lower than the baseline median WBC count for the breast cancer and NHL treatment groups respectively. Upon recovery of the bone marrow on day 21. the median WBC rose by 30% from the nadir obtained on day10 to 14 in both treatment groups. This was followed 10 to 14 days after the administration of the second cycle, by a median nadir count that was 40% lower than the day 21 median count. The ANC followed a similar trend. The median ANC reached a nadir that was 60% and 70% lower than the baseline median ANC for breast cancer and NHL treatment groups respectively, 10 to 14 days after the first cycle of chemotherapy was administered. Subsequently on day 21. the median ANC rose by 60% and 55% from the nadir median ANC for breast cancer and NHL treatment groups respectively. After the administration of the second cycle, the median ANC reached a nadir that was 60% lower than the median ANC on day 21. The median WBC nadir was lower in second cycle for both groups. The individual case nadir was lower in the first cycle for NHL and second cycle for breast cancer treatment group. For the ANC, the lowest median nadir was in cycle two in both groups and the individual case nadir was lowest in cycle one. Platelets did not show any pattern in trend during the phases of the cycle. The hemoglobin levels did not change significantly either. Conclusion: Our patients seem to suffer severe bone marrow toxicity. Sixty two percent of treatment schedule interruptions were due to neutropenia, 31 % due to anemia and only 7% due to low platelets. Febrile neutropenia was a rare occurrence though fatal when it occurred.