Myelosuppression: Causes & Reasons

Possible Causes for Myelosuppression

Drug-Induced Bone Marrow Suppression

Description Myelosuppression is a decrease in the production of blood cells. [encyclopedia.com]

Symptoms of Myelosuppression Myelosuppression does not hurt in and of itself. [mesothelioma-aid.org]

What do you need to know about myelosuppression? [verywell.com]

Philadelphia Chromosome-Positive Chronic Myeloid Leukemia

Myelosuppression was reported in patients with normal baseline laboratory values as well as in patients with pre-existing laboratory abnormalities. [news.bms.com]

Although a variety of medications have been used in chronic myeloid leukemia, including myelosuppressive agents and interferon alpha, the tyrosine kinase inhibitor imatinib [checkorphan.org]

The most common — 15% or more — included myelosuppression, headache, nausea, diarrhea, skin rash, pain in extremity and abdominal pain. [healio.com]

Pancytopenia

In very rare cases, it can also involve the bone marrow and the resulting cystine crystal deposition can cause myelosuppression leading to pancytopenia. [ncbi.nlm.nih.gov]

Bone marrow depression Myelosuppression 6-thioguanine Cytopenia Pancytopenia Bone marrow depression Myelosuppression BCNU Myelosuppression CAS 76095-16-4 Bone marrow depression [sideeffects.embl.de]

English These effects lead to a reduction of circulating red, white and coagulation blood cells (myelosuppressive effect). [mymemory.translated.net]

Chronic Myeloid Leukemia

Myelosuppressive drugs (eg, hydroxyurea ), stem cell transplantation, and interferon alfa are also sometimes used. [msdmanuals.com]

Drugs that inhibit bone marrow activity (myelosuppressive drugs) may slow the progression of the disease. [rarediseases.org]

Although a variety of medications have been used in chronic myeloid leukemia, including myelosuppressive agents and interferon alpha, the tyrosine kinase inhibitor imatinib [checkorphan.org]

Chronic Phase of Chronic Myeloid Leukemia

Tyrosine kinase inhibitors have been associated with myelosuppression and grade 3 or grade 4 cytopenias are not uncommon in chronic myeloid leukemia patients treated with [ncbi.nlm.nih.gov]

Two deaths were attributable to imatinib mesylate-associated myelosuppression. [clincancerres.aacrjournals.org]

[…] agent for inducing hematologic remission Busulfan: Myelosuppressive agent for inducing hematologic remission Omacetaxine (Synribo): Protein translation inhibitor indicated [emedicine.medscape.com]

Secondary Myelofibrosis

Grade 3 or higher myelosuppression occurred in 22 patients (88%), of whom 18 (82%) had a return to grade 2 or lower myelosuppression or to baseline values; plots of drug reintroduction [nejm.org]

However, lenalidomide was associated with significant myelosuppression. [clevelandclinicmeded.com]

My hope is that pacritinib might become an option for them because even though ruxolitinib is well tolerated, one of the downsides is often myelosuppression, and many patients [hematology.org]

Chronic Lymphocytic Leukemia

Although purine analogue based combinations produce complete responses (CRs) in many patients, the use of these combinations has been limited by toxicity including myelosuppression [oadoi.org]

Myelosuppression: TREANDA caused severe myelosuppression (Grade 3-4) in 98% of patients in the two NHL studies. [treanda.com]

Three patients (2%) died from myelosuppression-related adverse reactions. [treanda.com]

Myeloproliferative Disease

Other patients can undergo myelosuppressive therapy with hydroxyurea. Radioactive phosphorous can be used as an alternative therapy in older patients. [emedicine.com]

[…] vesicle Lymphoreticular injury Megakaryocytic hyperplasia of bone marrow Mild bone marrow hyperplasia Moderate bone marrow hyperplasia Myeloid hyperplasia of bone marrow Myelosuppression [icd9data.com]

Patients with painful, massively enlarged spleens refractory to myelosuppressive therapy are occasionally treated with radiation therapy, but they may ultimately require splenectomy [emedicine.com]

Primary Myelofibrosis

Mild myelosuppression can be seen with pegylated interferon; however, bone marrow aplasia in patients with myelofibrosis has not been reported. [ncbi.nlm.nih.gov]

SUMMARY: Combining JAK-inhibitors with agents that target parallel prosurvival pathways or agents that enhance hematopoiesis may enhance efficacy and/or mitigate on-target myelosuppression [ncbi.nlm.nih.gov]

Although thalidomide and lenalidomide can alleviate anemia in myelofibrosis, their use is limited by their respective potential to cause peripheral neuropathy and myelosuppression [askhematologist.com]

Leukoerythroblastic Anemia

However, lenalidomide was associated with significant myelosuppression. [clevelandclinicmeded.com]

Suppression of the bone marrow can co-exist with factors shortening red cell survival in many situations (for example, a cancer patient on a myelosuppressive chemotherapeutic [cancertherapyadvisor.com]

Aplastic Anemia

Azathioprine-induced aplastic anemia and fatal myelosuppression is a rare occurrence in patients with systemic lupus erythematosus (SLE). [ncbi.nlm.nih.gov]

Lack of in vitro colony (CFUC) formation and myelosuppressive activity in patients with severe aplastic anemia after autologous hematologic reconstitution. [springermedizin.at]

Mustard Gas Poisoning

[…] growth factor.  Limited clinical evidence suggests a significant role for mustard gas-induced myelosuppression in the overall morbidity of mustard gas victims.  Initial [slideshare.net]

Abstract The authors describe the development of a clinical protocol to treat mustard gas-induced myelosuppression with granulocyte colony stimulating factor (GCSF), a hematopoietic [slideshare.net]

Teniposide

Myelosuppression Risk of dose-limiting myelosuppression (e.g., neutropenia, leukopenia, thrombocytopenia, anemia). 1 2 5 6 8 9 Severe myelosuppression with resulting infection [drugs.com]

Severe myelosuppression with resulting infection or bleeding may occur. Hypersensitivity reactions. [empr.com]

MEASUREMENTS AND MAIN RESULTS: Blood counts, hospitalizations due to infection or myelosuppression, use of intravenous antibiotics, and survival parameters were analyzed. [ncbi.nlm.nih.gov]

Alkylating Agent

Carmustine, lomustine, streptozocin; bind to O-6 of guanine, highly lipophilic, cross blood brain barrier, cause prolonged myelosuppression Nitrosourea; given IV, but also [quizlet.com]

Dose escalation was terminated at 708 mg/m(2) for prolonged myelosuppression in 1 of 7 patients, and 600 mg/m(2) was selected as the recommended Phase II dose, with no significant [ncbi.nlm.nih.gov]

Dose-limiting toxicities (gastrointestinal and myelosuppression) were seen with 500 and 600 mg/m(2) of cloretazine combined with the 4-day ara-C schedule but not seen with [ncbi.nlm.nih.gov]

Topotecan

DLTs (myelosuppression) on the daily-times-five topotecan schedule. [ncbi.nlm.nih.gov]

The toxicity of topotecan, predominantly myelosuppression, was tolerable. [ncbi.nlm.nih.gov]

Dose-limiting toxicities included myelosuppression, ALT elevation, stomatitis, and hypertriglyceridemia. [ncbi.nlm.nih.gov]

Temozolomide

Recent reports have demonstrated that TMZ-induced myelosuppression correlates with survival in patients with GBM. [ncbi.nlm.nih.gov]

The incidence of gastrointestinal symptoms and ≥grade 3 myelosuppression presented statistical difference, TMZ+WBI group is higher than WBI group, the pooled risk ratio value [oadoi.org]

This study examined whether myelosuppression during concomitant TMZ phase correlates with prognosis in GBM, IDH-wildtype patients. [ncbi.nlm.nih.gov]

Hydroxyurea

Despite a serum level of 7,756 µM 4 hours post-ingestion, the only toxicity was transient mild myelosuppression. [ncbi.nlm.nih.gov]

Enhanced anti HIV activity of azidothymidine, dideocytidine and dideoxyinosine Toxicity Myelosuppression: The dose limiting toxicity of hydroxyurea is myelosuppression. [allaboutblood.com]

The most common side effect of hydroxyurea is myelosuppression. [bmcgastroenterol.biomedcentral.com]

Acute Radiation Sickness

Gy Lethal within hours In March 2015, filgrastim (Neupogen) was approved by the US Food and Drug Administration (FDA) to increase survival in patients acutely exposed to myelosuppressive [emedicine.medscape.com]

Spinal Cord Radiation

The most prominent affect tissues within the radiated field that contain rapidly dividing cells, and include • desquamation of the skin, • myelosuppression, • mucositis, diarrhea [slideshare.net]

Bone Radiation

SEQUELAE OF TREATMENT Acute effects Desquamation of the skin, myelosuppression, mucositis, diarrhea, nausea, and cystitis. [slideshare.net]

Vinorelbine

Myelosuppression with neutropenia and thrombocytopenia was the most common side effect observed with this combination regimen, and higher than grade 3 neutropenia and thrombocytopenia [ncbi.nlm.nih.gov]

Delay treatment until recovery and reduce vinorelbine by 25% for subsequent cycles Prolonged recovery greater than two weeks delay or 3rd delay for myelosuppression Delay [eviq.org.au]

However, myelosuppression (especially granulocytopenia) is the major dose-limiting toxicity. [prostatecancernewstoday.com]

5-Fluorouracil

Withhold fluorouracil until Grade 4 myelosuppression resolves; resume fluorouracil at a reduced dose when myelosuppression has resolved or improved to Grade 1 in severity. [dailymed.nlm.nih.gov]

These toxicities include mucositis, neutropenia, nausea, diarrhea, myelosuppression, hand-foot syndrome, and rare ocular adverse effects. [ncbi.nlm.nih.gov]

Fluorouracil can cause severe and fatal myelosuppression which may include neutropenia, thrombocytopenia, and anemia. [dailymed.nlm.nih.gov]

Paclitaxel

However, significant toxicities, such as myelosuppression and peripheral neuropathy, limit the effectiveness of paclitaxel-based treatment regimens. [ncbi.nlm.nih.gov]

Administration Irritant Mfr recommends administration over 1-24 hr Administer taxane derivatives before platinum derivatives (cisplatin, carboplatin) in sequential infusions to limit myelosuppression [reference.medscape.com]

Comment: Myelosuppressive agents can produce additive myelosuppression. [reference.medscape.com]

Chemotherapy

Table 1 Relationship between myelosuppression and anticancer effect If lack of myelosuppression is accepted as an indication of underdosing, the frequency of this event can [doi.org]

Myelosuppression, one of the most common toxicities of chemotherapy, results in varying degree of cytopenias. [ncbi.nlm.nih.gov]

Although treated patients had relatively high incidences of myelosuppression, hyperbilirubinemia, and elevated hepatic transaminases, the incidences of severe mucositis and [ncbi.nlm.nih.gov]

Flucytosine

Vigilance is also required when flucytosine is administered in combination with other myelosuppressive drugs. [apps.who.int]

Myelosuppression is more likely with elevated flucytosine serum levels. [life-worldwide.org]

Furthermore, drugs that are known to be myelosuppressive, such as zidovudine, should be used with caution in patients receiving 5-FC. 73 However, there is no evidence that [doi.org]

Uracil Mustard

Adverse Reactions >10%: Gastrointestinal: Nausea, vomiting, diarrhea Hematologic: Myelosuppressive; leukopenia and thrombocytopenia nadir: 2-4 weeks, anemia 1% to 10%: Central [syrianclinic.com]

[…] cough or hoarseness; fever or chills; lower back or side pain; painful or difficult urination; pinpoint red spots on skin; unusual bleeding or bruising) Note: Cumulative myelosuppression [drugs.com]

[…] weeks Thrombocytosis: 1-2 mg/day for 14 days Mental Health: Effects on Mental Status May cause nervousness or depression Mental Health: Effects on Psychiatric Treatment Myelosuppression [syrianclinic.com]

Gold Salt

INTERACTIONS Increased risk of toxicity with other nephrotoxic and myelosuppressive drugs. MECHANISM OF ACTION / TOXICITY Acute: No deaths have been recorded. [inchem.org]

Side Effects: Fortunately the most serious complications of methotrexate therapy: hepatic cirrhosis, interstitial pneumonitis, and severe myelosuppression are quite rare, [hopkinsarthritis.org]

Interstitial pneumonitis is a rare complication of methotrexate ( Myelosuppression (lowering of blood counts) is also rare at the low doses of methotrexate utilized for rheumatoid [hopkinsarthritis.org]

Mediastinal Irradiation

These agents induce greater response than cisplatin does but may be more myelosuppressive. [emedicine.medscape.com]

[Epub ahead of print]) Outcome: Median PFG gefitinib 9 months vs. cisplatin/docetaxel 6 months (SS) Toxicity: Myelosuppression, alopecia, and fatigue more frequent in cisplatin [en.wikibooks.org]

Cisplatin is recognized as an excellent agent because of its superior activity and its only modest myelosuppression. [emedicine.medscape.com]

Radiation Exposure

Latent phase - Myelosuppression is the hallmark of latent phase, developing between 1 and 5 weeks after initial exposure, again depending on the severity of exposure. [symptoma.com]

In March 2015, filgrastim (Neupogen) was approved by the FDA to increase survival in patients acutely exposed to myelosuppressive doses of radiation (suspected or confirmed [emedicine.medscape.com]

Additionally, acute respiratory distress syndrome (ARDS), purpura, electrolyte disturbances and infection due to severe myelosuppression that may lead to sepsis are frequently [symptoma.com]

Arsenic Trioxide

It does not cause hair loss and is not myelosuppressive in patients with APL. [ncbi.nlm.nih.gov]

Two patients did not complete maintenance therapy because of prolonged myelosuppression (>50 days). [nejm.org]