Relationship between monocytopenia and neutropenia during concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma and cervical cancer
Dong Xiaohe, Yang Yongqiang, Zhao Peifeng, Qian Jianjun, Zhang Liyuan, Tian Ye
Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University;Institute of Radiotherapy & Oncology, Soochow University;Suzhou Key Laboratory for Radiation Oncology, Suzhou 215004, China
Abstract:Objective To evaluate whether the decrease in peripheral blood monocyte count was a potential predictor for neutropenia in patients with nasopharyngeal carcinoma and cervical cancer. Methods The medical records of 95 patients with nasopharyngeal carcinoma and cervical carcinoma who received intensity-modulated radiation therapy (IMRT) combined with paclitaxel liposomes and platinum (TP) synchronous chemotherapy and presented with neutropenia in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were retrospectively analyzed. Paired sample t-test was used to assess whether the number of days when the monocytes initially dropped/decreased to lowest level/eventually increased to normal value was significantly less than those of the neutrophils. In addition, the chi-square test was performed to determine the correlation between the degree of reduction in the absolute neutrophil count (ANC) and baseline absolute monocyte count (AMC). Results The change trend of AMC was consistent with that of ANC in the two cycles of concurrent chemotherapy. The number of days when AMC initially decreased/decreased to the lowest level/finally increased to normal value was significantly less than that of ANC (4 d vs. 6 d, 4 d vs. 10 d, P<0.001;5 d vs. 6 d, 6 d vs. 9 d, 7 d vs. 12 d, P<0.001). However, no correlation was found between the baseline level of monocytes and the degree of subsequent neutropenia [(AMC<0.4×109 )vs.( AMC≥0.4×109)=32 vs. 63,P=0.172]. Conclusions Decreased monocyte count is an important potential predictor for neutropenia and a significant indicator for guiding the next monitoring of neutrophil count and treatment with granulocyte colony-stimulating factor.
Dong Xiaohe,Yang Yongqiang,Zhao Peifeng et al. Relationship between monocytopenia and neutropenia during concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma and cervical cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(1): 16-22.
[1] Rosenzweig KE, Gomez JE. Concurrent chemotherapy and radiation therapy for inoperable locally advanced non-small-cell lung cancer[J]. J Clin Oncol, 2017, 35(1):6-10. DOI:10.1200/JCO.2016.69.9678. [2] Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer:results of the German CAO/ARO/AIO-94 randomized phase Ⅲ trial after a median follow-up of 11 years[J]. J Clin Oncol, 2012, 30(16):1926-1933. DOI:10.1200/JCO.2011.40.1836. [3] Datta NR, Stutz E, Liu M, et al. Concurrent chemoradiotherapy vs. radiotherapy alone in locally advanced cervix cancer:a systematic review and meta-analysis[J]. Gynecol Oncol, 2017, 145(2):374-385. DOI:10.1016/j.ygyno.2017.01.033. [4] Blanchard P, Lee A, Marguet S, et al. Chemotherapy and radiotherapy in nasopharyngeal carcinoma:an update of the MAC-NPC meta-analysis[J]. Lancet Oncol, 2015,16:645-655. DOI:10.1016/S1470-2045(15)70126-9. [5] Crawford J, Dale DC, Kuderer NM, et al. Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy:the results of a prospective nationwide study of oncology practice[J]. J Natl Compr Canc Netw, 2008, 6(2):109-118. DOI:10.6004/jnccn.2019.7289. [6] De Boer SM, Powell ME, Mileshkin L, et al. Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3):an open-label, multicentre, randomised, phase 3 trial[J]. Lancet Oncol, 2016, 17(8):1114-1126. DOI:10.1016/S1470-2045(16)30120-6. [7] Leonard RC, Mansi JL, Keerie C, et al. A randomised trial of secondary prophylaxis using granulocyte colony-stimulating factor (‘SPROG′trial) for maintaining dose intensity of standard adjuvant chemotherapy for breast cancer by the Anglo-Celtic Cooperative Group and NCRN[J]. Ann Oncol, 2015, 26(12):2437-2441. DOI:10.1093/annonc/mdv389. [8] Kondo M, Oshita F, Kato Y, et al. Early monocytopenia after chemotherapy as a risk factor for neutropenia[J]. Am J Clin Oncol, 1999, 22(1):103-105. DOI:10.1097/00000421-199902000-00025. [9] Oshita F, Yamada K, Nomura I, et al. Prophylactic aDministration of granulocyte colony-stimulating factor when monocytopenia appears lessens neutropenia caused by chemotherapy for lung cancer[J]. Am J Clin Oncol,2000,23(3):278-282. DOI:10.1097/00000421-200006000-00014. [10] Sato I, Nakaya N, Shimasaki T, et al. Prediction of docetaxel monotherapy-induced neutropenia based on the monocyte percentage[J]. Oncol Lett, 2012, 3(4):860-864. DOI:10.3892/ol.2012.556. [11] Moriyama Y, Horita N, Kudo M, et al. Monocyte nadir is a possible indicator for neutrophil nadir during lung cancer chemotherapy[J]. Clin Respir J, 2017, 11(4):453-458. DOI:10.1111/crj.12358. [12] Ouyang W, Liu Y, Deng D, et al. The change in peripheral blood monocyte count:a predictor to make the management of chemotherapy-induced neutropenia[J]. J Cancer Res Ther, 2018, 14:565-570. DOI:10.4103/0973-1482.177502. [13] Shimanuki M, Imanishi Y, Sato Y, et al. Pretreatment monocyte counts and neutrophil counts predict the risk for febrile neutropenia in patients undergoing TPF chemotherapy for head and neck squamous cell carcinoma[J]. Oncotarget, 2018, 9(27):18970-18984. DOI:10.18632/oncotarget.24863. [14] Zheng B, Huang Z, Huang Y, et al. Predictive value of monocytes and lymphocytes for short-term neutrophil changes in chemotherapy-induced severe neutropenia in solid tumors[J]. Support Care Cancer, 2019, 28(3):1289-1294. DOI:10.1007/s00520-019-04946-3. [15] Chen SW, Liang JA, Yang SN, et al. The adverse effect of treatment prolongation in cervical cancer by high-dose-rate intracavitary brachytherapy[J]. Radiother Oncol, 2003, 67(1):69-76. DOI:10.1016/s0167-8140(02)00439-5. [16] Mazeron R, Castelnau-Marchand P, Dumas I, et al. Impact of treatment time and dose escalation on local control in locally advanced cervical cancer treated by chemoradiation and image-guided pulsed-dose rate adaptive brachytherapy[J]. Radiother Oncol, 2015, 114(2):257-263. DOI:10.1016/j.radonc.2014.11.045. [17] Lin SM, Ku HY, Chang TC, et al. The prognostic impact of overall treatment time on disease outcome in uterine cervical cancer patients treated primarily with concomitant chemoradiotherapy:a nationwide Taiwanese cohort study[J]. Oncotarget, 2017, 8(49):85203-85213. DOI:10.18632/oncotarget.19617. [18] Phillips R, Hancock B, Graham J, et al. Prevention and management of neutropenic sepsis in patients with cancer:summary of NICE guidance[J]. BMJ, 2012, 345:e5368. DOI:10.1136/bmj.e5368. [19] 中国医师协会肿瘤医师分会,中国抗癌协会肿瘤临床化疗专业委员会,《中华医学杂志》编辑委员会. 中国重组人粒细胞集落刺激因子在肿瘤化疗中的临床应用专家共识(2015年版)[J]. 中华医学杂志, 2015, 95(37):3001-3003. DOI:10.3760/cma.j.issn.0376-2491.2015.37.001. Society of Oncologists, Chinese Medical Doctor Association, Society for Clinical Cancer Chemotherapy, Chinese Anti-cancer Association, the Editorial Board of Chinese Medical Journal. Expert consensus on the clinical application of recombinant human granulocyte colony stimulating factor in tumor chemotherapy in China (2015 Version)[J]. Chin Med J, 2015, 95(37):3001-3003. DOI:10.3760/cma.j.issn.0376-2491.2015.37.001. [20] 中国临床肿瘤学会指南工作委员会. 肿瘤放化疗相关中性粒细胞减少症规范化管理指南[J]. 中华肿瘤杂志, 2017, 39(11):868-878. DOI:10.3760/cma.j.issn.0253-3766.2017.11.011. Experts Committee on Guidelines, Chinese Society of Clinical Oncology (CSCO). Guidelines for standardized management of neutropenia induced by chemotherapy and radiotherapy[J]. Chin J Oncol, 2017, 39(11):868-878. DOI:10.3760/cma.j.issn.0253-3766.2017.11.011. [21] Metcalf D. The granulocyte-macrophage colony stimulating factors[J]. Cell, 1985, 43(1):5-6. DOI:10.1016/0092-8674(85)90004-2. [22] Metcalf D. The molecular control of cell division, differentiation commitment and maturation in haemopoietic cells[J]. Nature, 1989, 339(6219):27-30. DOI:10.1038/339027a0. [23] Sugimoto Y, Katayama N, Masuya M, et al. Differential cell division history between neutrophils and macrophages in their development from granulocyte-macrophage progenitors[J]. Br J Haematol, 2006, 135:725-731. DOI:10.1111/j.1365-2141.2006.06367.x.