Neutropenia

Overview

• 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.