{"entity":{"id":"neutropenia","kind":"term","name":"Neutropenia","aka":["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"],"tldr":"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.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Neutropenia","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Neutropenia"},{"label":"Macmillan: sepsis","url":"https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/sepsis"},{"label":"NICE CG151: neutropenic sepsis","url":"https://www.nice.org.uk/guidance/cg151"},{"label":"Breast Cancer Now: sacituzumab govitecan (Trodelvy)","url":"https://breastcancernow.org/about-breast-cancer/treatment/targeted-therapy/sacituzumab-govitecan-trodelvy"},{"label":"Macmillan: FOLFIRINOX","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfirinox"},{"label":"Macmillan: nab-paclitaxel (Abraxane)","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/nab-paclitaxel"},{"label":"Macmillan: FOLFOX","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfox"},{"label":"Macmillan: irinotecan","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/irinotecan"},{"label":"Lymphoma Action: neutropenia (low neutrophils)","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/neutropenia-low-neutrophils"},{"label":"Lymphoma Action: growth factors","url":"https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/growth-factors"}],"tags":[],"related":["febrile-neutropenia","cytopenias","thrombocytopenia","dose-modification"],"cancers":["tnbc","pancreatic","colorectal","non-hodgkin-lymphoma","dlbcl","follicular-lymphoma","mantle-cell-lymphoma","marginal-zone-lymphoma","malt-lymphoma","splenic-marginal-zone-lymphoma","nodal-marginal-zone-lymphoma","waldenstrom","primary-mediastinal-b-cell-lymphoma","burkitt-lymphoma","hodgkin-lymphoma","early-stage-classical-hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma","relapsed-refractory-hodgkin-lymphoma","nodular-lymphocyte-predominant-hodgkin-lymphoma","peripheral-t-cell-lymphoma","angioimmunoblastic-t-cell-lymphoma","cutaneous-t-cell-lymphoma","sezary-syndrome","primary-cns-lymphoma"],"sections":["supportive-care"],"technologies":["g-csf-growth-factors"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"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."],"category":"Side effects"},"route":"/terms/neutropenia/","neighbours":{"term":[{"id":"cytopenias","kind":"term","name":"Cytopenias and myelosuppression","route":"/terms/cytopenias/"},{"id":"dose-modification","kind":"term","name":"Dose reduction, interruption and discontinuation","route":"/terms/dose-modification/"},{"id":"dose-dense-chemotherapy","kind":"term","name":"Dose-dense and metronomic chemotherapy","route":"/terms/dose-dense-chemotherapy/"},{"id":"febrile-neutropenia","kind":"term","name":"Febrile neutropenia","route":"/terms/febrile-neutropenia/"},{"id":"lymphoma-tx-pjp-and-infection-prophylaxis","kind":"term","name":"Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination","route":"/terms/lymphoma-tx-pjp-and-infection-prophylaxis/"},{"id":"adc-side-effects-breast","kind":"term","name":"Living with an antibody-drug conjugate: diarrhoea, blood counts, eyes and lungs","route":"/terms/adc-side-effects-breast/"},{"id":"chemotherapy-side-effects-pancreatic","kind":"term","name":"Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel","route":"/terms/chemotherapy-side-effects-pancreatic/"},{"id":"chemotherapy-side-effects-colorectal","kind":"term","name":"Living with FOLFOX, CAPOX, FOLFIRI and the EGFR antibodies","route":"/terms/chemotherapy-side-effects-colorectal/"},{"id":"lymphoma-living-infection-years-after","kind":"term","name":"Low antibodies and infection risk for years after anti-CD20 and bispecific antibodies","route":"/terms/lymphoma-living-infection-years-after/"},{"id":"neutropenic-sepsis-breast-chemotherapy","kind":"term","name":"Neutropenic sepsis: the temperature rule and the 999 signs","route":"/terms/neutropenic-sepsis-breast-chemotherapy/"},{"id":"tnbc-symptom-control-palliation","kind":"term","name":"Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life","route":"/terms/tnbc-symptom-control-palliation/"},{"id":"thrombocytopenia","kind":"term","name":"Thrombocytopenia","route":"/terms/thrombocytopenia/"},{"id":"urgent-help-bowel-cancer","kind":"term","name":"When to seek urgent help with bowel cancer (NHS 111 and 999)","route":"/terms/urgent-help-bowel-cancer/"}],"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"cutaneous-t-cell-lymphoma","kind":"cancer","name":"Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)","route":"/cancers/cutaneous-t-cell-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"malt-lymphoma","kind":"cancer","name":"Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)","route":"/cancers/malt-lymphoma/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"nodal-marginal-zone-lymphoma","kind":"cancer","name":"Nodal marginal zone lymphoma","route":"/cancers/nodal-marginal-zone-lymphoma/"},{"id":"angioimmunoblastic-t-cell-lymphoma","kind":"cancer","name":"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)","route":"/cancers/angioimmunoblastic-t-cell-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"primary-cns-lymphoma","kind":"cancer","name":"Primary CNS lymphoma","route":"/cancers/primary-cns-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"sezary-syndrome","kind":"cancer","name":"Sezary syndrome","route":"/cancers/sezary-syndrome/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"},{"id":"splenic-marginal-zone-lymphoma","kind":"cancer","name":"Splenic marginal zone lymphoma","route":"/cancers/splenic-marginal-zone-lymphoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"dpyd-genotyping","kind":"technology","name":"DPYD genotyping and DPD phenotyping before fluoropyrimidines","route":"/technologies/dpyd-genotyping/"},{"id":"g-csf-growth-factors","kind":"technology","name":"Growth factors: G-CSF and febrile neutropenia prevention","route":"/technologies/g-csf-growth-factors/"},{"id":"tpmt-nudt15-genotyping","kind":"technology","name":"TPMT and NUDT15 genotyping before thiopurines","route":"/technologies/tpmt-nudt15-genotyping/"},{"id":"ugt1a1-genotyping","kind":"technology","name":"UGT1A1 genotyping before irinotecan","route":"/technologies/ugt1a1-genotyping/"}],"trial":[{"id":"mpact","kind":"trial","name":"MPACT","route":"/trials/mpact/"}],"target":[{"id":"csf3r","kind":"target","name":"G-CSF receptor (CSF3R)","route":"/targets/csf3r/"}],"company":[{"id":"beyondspring","kind":"company","name":"BeyondSpring Pharmaceuticals","route":"/companies/beyondspring/"},{"id":"changchun-genescience","kind":"company","name":"Changchun GeneScience Pharmaceutical","route":"/companies/changchun-genescience/"},{"id":"evive-biotech","kind":"company","name":"Evive Biotech","route":"/companies/evive-biotech/"},{"id":"g1-therapeutics","kind":"company","name":"G1 Therapeutics","route":"/companies/g1-therapeutics/"},{"id":"partner-therapeutics","kind":"company","name":"Partner Therapeutics","route":"/companies/partner-therapeutics/"},{"id":"spectrum-pharmaceuticals","kind":"company","name":"Spectrum Pharmaceuticals","route":"/companies/spectrum-pharmaceuticals/"}]}}