Current management of chemotherapy-induced neutropenia in adults: key points and new challenges: Committee of Neoplastic Supportive-Care (CONS), China Anti-Cancer Association Committee of Clinical Chemotherapy, China Anti-Cancer Association.

Qinghua Yao, Herui Yao, Conghua Xie, Huiqiang Huang, Wangjun Liao, Gongyan Chen, Xiaotian Zhang, Hanxiang An, Yanhong Deng, Ping Gong, Jianping Xiong, Li Zhang, Xin An, Cheng Chen, Yanxia Shi, Jialei Wang, Xiaohua Wang, Zhiqiang Wang, Puyuan Xing, Sheng Yang, Chenfei Zhou, Bo Shen, Yuankai Shi, Wenqi Jiang, Jifeng Feng, Ying Cheng, Li Xiao, Qingyuan Zhang, Wensheng Qiu, Binghe Xu, Ruihua Xu, Yi Ba, Zhiguo Luo, Xiaodong Xie, Jianhua Chang, Mengzhao Wang, Yufu Li, Yuerong Shuang, Zuoxing Niu, Bo Liu, Jun Zhang

Journal: Cancer biology & medicine 2021;17(4):896-909

PMID: 33299642

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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.

Address: 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.

DOI: 10.20892/j.issn.2095-3941.2020.0069

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MeSH Terms: Adult, Anti-Bacterial Agents, Antineoplastic Agents, Chemotherapy-Induced Febrile Neutropenia, China, Clinical Decision-Making, Emergency Service, Hospital, Granulocyte Colony-Stimulating Factor, Humans, Neoplasms, Risk Assessment, Risk Factors