Low white blood cell count cancer
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Low White Blood Cell Count in Cancer Patients: Implications and Management
Impact of Low White Blood Cell Count on Chemotherapy and Cancer Survival
Low white blood cell (WBC) counts, particularly neutropenia, can significantly impact the treatment and prognosis of cancer patients. Neutropenia often delays or prevents the completion of chemotherapy, which is crucial for the effective treatment of cancers such as breast and colon cancer. This delay can adversely affect cancer survival rates, especially among women receiving adjuvant therapy1.
Association with Epstein-Barr Virus Infection
Cancer patients undergoing chemotherapy are at an increased risk of infections due to low WBC counts. A study conducted in Iraq found a significant association between Epstein-Barr virus (EBV) infection and low WBC counts in cancer patients. This relationship underscores the vulnerability of immunocompromised patients to viral infections, which can complicate cancer treatment and recovery2.
Prognostic Value of White Blood Cell Counts in Colorectal Cancer
WBC counts can serve as prognostic markers in colorectal cancer. High preoperative WBC counts have been linked to poor prognosis and are associated with an immunosuppressive tumor microenvironment. This includes higher levels of regulatory T cells, CD68+ macrophages, and CD66b+ neutrophils, which can inhibit the body's immune response against tumors8. Additionally, low pre-treatment basophil counts and high post-treatment neutrophil ratios are independent prognostic factors affecting overall survival in colorectal cancer patients5.
Risk of Venous Thromboembolism
Elevated WBC counts prior to cancer development have been associated with an increased risk of venous thromboembolism (VTE) in cancer patients. This risk is not observed in cancer-free individuals, suggesting a causal role of leukocytes in cancer-related VTE. High WBC counts in cancer patients are linked to a 2.4-fold higher risk of VTE, highlighting the importance of monitoring WBC levels as part of cancer management3.
Treatment Strategies for Low White Blood Cell Counts
Several strategies have been explored to manage low WBC counts in cancer patients. For instance, the administration of 12-O-tetradecanoylphorbol-13-acetate (TPA) has been shown to increase WBC and neutrophil counts in patients treated with cytotoxic chemotherapy, bringing these counts closer to normal levels4. Additionally, the use of antibiotic combinations, such as piperacillin with ciprofloxacin or tobramycin, has been effective in treating infections in patients with low WBC counts, although the efficacy and safety of these combinations are similar7.
Conclusion
Low WBC counts in cancer patients pose significant challenges, including increased infection risk, delayed chemotherapy, and poorer prognosis. Understanding the implications of WBC counts and employing effective management strategies are crucial for improving outcomes in cancer patients. Monitoring and addressing low WBC counts can help mitigate risks and enhance the efficacy of cancer treatments.
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Most relevant research papers on this topic
Neutropenia in 6 ethnic groups from the Caribbean and the U.S.
Low white blood cell and absolute neutrophil counts are more common in African-American women than in European-American women, and may affect chemotherapy completion and cancer survival.
Observational StudyEpstein–Barr Virus Infection Related to Low White Blood Cell Count in Cancer Patients Receiving Chemotherapy in Al-Najaf Governorate/Iraq
EBV infection is associated with low white blood cell counts in cancer patients receiving chemotherapy, with no significant differences observed between age and gender.
Observational StudyWhite Blood Cell Count Measured Prior to Cancer Development Is Associated with Future Risk of Venous Thromboembolism – The Tromsø Study
Pre-cancer white blood cell count is associated with increased risk of venous thromboembolism in cancer patients, but not in cancer-free subjects, suggesting leukocytes may play a causal role in cancer-related VTE.
Observational Study
Rigorous Journal12-O-Tetradecanoylphorbol-13-acetate (TPA)-induced increase in depressed white blood cell counts in patients treated with cytotoxic cancer chemotherapeutic drugs.
TPA infusions effectively increase depressed white blood cell and neutrophil counts in cancer patients treated with cytotoxic cancer chemotherapeutic drugs, with only mild and reversible side effects.
Non-RCTValues of applying white blood cell counts in the prognostic evaluation of resectable colorectal cancer.
Low pre-treatment BA levels are associated with larger tumor size and poor overall survival in resectable colorectal cancer patients, while surgery significantly decreases BA levels.
Non-RCTRigorous JournalElevated white blood cell count and outcome in cancer patients with venous thromboembolism
Elevated white blood cell count in cancer patients with acute venous thromboembolism is associated with an increased risk of recurrence, major bleeding, or death.
Observational StudyTreatment of Fever in Hospitalized Patients with Low White Blood Cell Counts
Piperacillin plus ciprofloxacin and piperacillin plus tobramycin both have similar efficacy and safety for treating fever in hospitalized cancer patients with low white blood cell counts.
RCT
Large Human TrialHigh preoperative white blood cell count determines poor prognosis and is associated with an immunosuppressive microenvironment in colorectal cancer
A high preoperative white blood cell count is associated with a poor prognosis in colorectal cancer patients and an immunosuppressive tumor microenvironment, which could aid in future risk stratification.
Observational StudyGene Signature of High White Blood Cell Count in B-Precursor Acute Lymphoblastic Leukemia
16 genes, including IL1R1, BCAR3, KCNH2, PIR, and ZDHHC23, are associated with high white blood cell count in B-precursor acute lymphoblastic leukemia patients, potentially identifying new therapeutic targets.
In Vitro StudyRigorous JournalIncreased post‐induction intensification improves outcome in children and adolescents with a markedly elevated white blood cell count (≥200 × 109/l) with T cell acute lymphoblastic leukaemia but not B cell disease: a report from the Children's Oncology Group
Increased post-induction intensification improves outcomes in children and adolescents with T cell acute lymphoblastic leukemia, but not in B cell disease, suggesting that B lineage disease negatively impacts survival in these high-risk patients.
Observational Study