# Neutropenia

Source: https://onco.cc/terms/neutropenia/  
OnCo record `neutropenia` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A shortage of neutrophils, the white blood cells that fight bacteria, caused by chemotherapy hitting the bone marrow. It usually bottoms out (the nadir) 7-14 days after each cycle and recovers before the next; while low, infection risk is high.

## Summary

The commonest dose-limiting toxicity of cytotoxic chemotherapy and of several targeted drugs (CDK4/6 inhibitors, PARP inhibitors, sacituzumab govitecan) and cell therapies. Graded by absolute neutrophil count (grade 3 <1.0, grade 4 <0.5 × 10⁹/L); severity and duration determine infection risk and febrile neutropenia. Managed by dose delays and reductions, prophylactic G-CSF, and for some drugs (palbociclib) simply tolerated because it is uncomplicated. Trilaciclib protects marrow during chemotherapy in small-cell lung cancer. Prolonged cytopenias after CAR-T (ICAHT) and after lymphodepletion are distinct in mechanism and can last months.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: neutropenic; neutropaenia; low neutrophils; neutrophil count; absolute neutrophil count; ANC; grade 4 neutropenia; grade 3-4 neutropenia; prolonged neutropenia; nadir; count nadir; leukopenia; leucopenia; white cell count; agranulocytosis

## Notes

- Carboplatin-paclitaxel, anthracycline chemotherapy and sacituzumab govitecan all lower white cells; NICE NG101 notes neutropenic sepsis, neutropenia, thrombocytopenia and anaemia are more frequent with platinum-based chemotherapy. Macmillan says a minor infection can become life-threatening within hours when neutrophils are low, to buy a thermometer, and to ring the 24-hour helpline for a temperature over 37.5 C or below 36 C, or for feeling unwell even with a normal temperature.
- Breast Cancer Now says growth factor injections are sometimes recommended with sacituzumab govitecan to reduce the risk of infection; NICE CG151 says G-CSF is not routine for everyone but is used where a regimen needs it or to keep the dose on time.
- FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel all lower white cells. Macmillan says to ring the 24-hour number straight away for a temperature above 37.5 C or below 36 C, or for feeling unwell even with a normal temperature; blood counts are checked before each dose and treatment is delayed if they are low.
- FOLFOX, CAPOX, FOLFIRI and irinotecan all lower white cells. Macmillan says to contact the hospital straight away on the 24-hour number for a temperature outside the range your team gave you, shivering, or feeling unwell even with a normal temperature; blood counts are checked before each cycle and treatment is delayed when they are low.
- Lymphoma: Lymphoma Action says a neutrophil count below 1 billion per litre is generally classed as neutropenia, that the reference range is usually 2 to 7.5 billion per litre, and that ranges differ between people and between ethnic groups, with people of African, Caribbean, Middle Eastern and West Indian descent often having naturally lower counts without a higher infection risk. It says there is limited scientific research supporting a neutropenic diet and that advice varies between hospitals, so the team's own instructions are the ones to follow.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Neutropenia
- Wikipedia: https://en.wikipedia.org/wiki/Neutropenia
- Macmillan: sepsis: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/sepsis
- NICE CG151: neutropenic sepsis: https://www.nice.org.uk/guidance/cg151
- Breast Cancer Now: sacituzumab govitecan (Trodelvy): https://breastcancernow.org/about-breast-cancer/treatment/targeted-therapy/sacituzumab-govitecan-trodelvy
- Macmillan: FOLFIRINOX: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfirinox
- Macmillan: nab-paclitaxel (Abraxane): https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/nab-paclitaxel
- Macmillan: FOLFOX: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfox
- Macmillan: irinotecan: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/irinotecan
- Lymphoma Action: neutropenia (low neutrophils): https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/neutropenia-low-neutrophils
- Lymphoma Action: growth factors: https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/growth-factors

## Connected records

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- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [DPYD genotyping and DPD phenotyping before fluoropyrimidines](https://onco.cc/technologies/dpyd-genotyping/), [Growth factors: G-CSF and febrile neutropenia prevention](https://onco.cc/technologies/g-csf-growth-factors/), [TPMT and NUDT15 genotyping before thiopurines](https://onco.cc/technologies/tpmt-nudt15-genotyping/), [UGT1A1 genotyping before irinotecan](https://onco.cc/technologies/ugt1a1-genotyping/)
- trials: [MPACT](https://onco.cc/trials/mpact/)
- targets: [G-CSF receptor (CSF3R)](https://onco.cc/targets/csf3r/)
- companies: [BeyondSpring Pharmaceuticals](https://onco.cc/companies/beyondspring/), [Changchun GeneScience Pharmaceutical](https://onco.cc/companies/changchun-genescience/), [Evive Biotech](https://onco.cc/companies/evive-biotech/), [G1 Therapeutics](https://onco.cc/companies/g1-therapeutics/), [Partner Therapeutics](https://onco.cc/companies/partner-therapeutics/), [Spectrum Pharmaceuticals](https://onco.cc/companies/spectrum-pharmaceuticals/)

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