Incidence of Chemotherapy-induced Severe Neutropenia in Nadir Period in Gynecologic Cancer Patients Receiving Carboplatin and Paclitaxel

Abstract

Objectives: This study aimed to determine the incidence of chemotherapy-induced severe neutropenia in the nadir period among gynecologic cancer patients receiving carboplatin and paclitaxel. Materials and Methods: This prospective cohort study recruited 150 gynecologic cancer patients receiving carboplatin and paclitaxel. Complete blood counts were collected before receiving chemotherapy and during the nadir period of each cycle, followed until discontinuation of the regimen or completion of six cycles, to evaluate the incidence of severe neutropenia. Results: A total of 793 cycles were analyzed in 150 patients. Severe neutropenia occurred in 366 cycles and 111 patients during the nadir periods, with 46.2% per cycle and 74.0% per patient, respectively. The incidence tended to increase in later cycles. The prior use of granulocyte-colony stimulating factor was 2.9%. The incidence of febrile neutropenia was 4.7%. No additional treatment for severe neutropenia was provided in 80.2%. Postmenopausal status and an initial white blood cell count below 7,000 cells/μL were significant risk factors for severe neutropenia.Additionally, an initial absolute neutrophil count (ANC) below 5,000 cells/ μL was a significant risk factor for febrile neutropenia. Conclusion: Despite severe neutropenia being relatively common during the nadir periods, the majority did not receive further management and subsequently recovered. Furthermore, the incidence of febrile neutropenia was low. Therefore, evaluation of ANC in nadir periods should be selectively performed in patients at risk for severe and febrile neutropenia.