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Annals of Oncology Advance Access published online on August 13, 2008
Annals of Oncology, doi:10.1093/annonc/mdn560
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Pretreatment haematological laboratory values predict for excessive myelosuppression in patients receiving adjuvant FEC chemotherapy for breast cancer

P. Jenkins1,* and S. Freeman2

1 Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham
2 Department of Haematology, University of Birmingham Medical School, Birmingham, UK

* Correspondence to: Dr P. Jenkins, Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, GL50 2LR, UK. Tel: +44-8454-224019; Fax: +44-8454-223506; E-mail: peter.jenkins{at}glos.nhs.uk

Background: A predictive model that identifies patients at risk of excessive neutropenia following chemotherapy would be valuable in guiding the use of supportive therapies.

Patients and methods: We conducted a retrospective analysis of 741 patients who had received adjuvant 5-fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy for breast cancer. The cause of every schedule alteration was identified. The ability of pretreatment haematological indices to predict for excessive myelosuppression was assessed.

Results: Pretreatment absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) were strongly associated with the risk of neutropenic events (NEs), febrile neutropenia (FN) or receiving suboptimal chemotherapy dose intensity (DI < 85%). The timing and pattern of NEs suggest that they reflect intrinsic chemosensitivity rather than cumulative toxicity and that FN results from chance infection rather than protracted myelosuppression. By combining quintiles on the basis of the rank order of ANC and ALC, we defined five groups of patients with variable risks of NE (18%–52%), DI <85% (9%–36%) and FN (4%–21%).

Conclusions: Pretreatment differential white blood cell count can be used to identify patients at increased risk of significant myelosuppression with FEC chemotherapy. Patients in the highest risk group have a risk of FN >20% and would qualify for primary prophylaxis with granulocyte colony-stimulating factor support under current guidelines.

breast cancer, chemotherapy, myeloid growth factors, neutropenia, risk models

Received for publication May 16, 2008. Accepted for publication July 14, 2008.


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