title: Can grade 2 neutropenia predict the risk of grade 3 neutropenia in metastatic colorectal cancer patients treated with chemotherapy?
abstract: OBJECTIVE
  Neutropenia is a major factor affecting continuation of chemotherapy for colorectal cancer. In many clinical trials, a neutrophil count of >1500 is targeted for continuation; for a count of <1500, medication is commonly discontinued. However, there is no definitive evidence supporting the need for a neutrophil count of 1500 for continuation of chemotherapy. In the clinical trials that we conducted, we discontinued chemotherapy when the neutrophil count was <1000 (grade 3); for a count of 1000-1500 (grade 2), chemotherapy was continued. Therefore, even practical treatment uses the same setting. Our aim was to examine neutrophil counts during continuation of chemotherapy in colorectal cancer patients with counts of 1000-1500 and to assess the need for discontinuation of medication for neutrophil counts in this range. Moreover, we examined neutrophil counts during the previous course of chemotherapy when they fell below 1000.
  
  
  METHODS
  The study included 144 patients who received XELOX + bevacizumab therapy and XELOX therapy for advanced or recurrent colorectal cancer.
  
  
  RESULTS
  Thirty (20.8 %) patients had neutrophil counts of 1000-1500. One (3.3 %) of 30 patients had a neutrophil count of <1000 during the following course of chemotherapy. Moreover, among the patients with neutrophil counts of <1000, 27.3 % had counts of 1000-1500 during the previous course of chemotherapy and 72.7 % had counts of >1500.
  
  
  CONCLUSIONS
  Based on these results, grade 2 neutropenia cannot predict the risk of grade 3 neutropenia. Continuation of chemotherapy in patients with neutrophil counts of 1000-1500 may be appropriate, and discontinuation of therapy is not always required.
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan, yy4160@yahoo.co.jp.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Hoshino
authors.forename: Naoya
authors.initials: N
authors.lastname: Aisu
authors.forename: Ai
authors.initials: A
authors.lastname: Mogi
authors.forename: Teppei
authors.initials: T
authors.lastname: Yamada
authors.forename: Daibo
authors.initials: D
authors.lastname: Kojima
authors.forename: Syu
authors.initials: S
authors.lastname: Tanimura
authors.forename: Keiji
authors.initials: K
authors.lastname: Hirata
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D000068258:Bevacizumab; D000069287:Capecitabine; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000209:etiology / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000097:blood* / Q000188:drug therapy*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy; D009504:Neutrophils / Q000187:drug effects / Q000473:pathology; D010071:Oxaloacetates; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D010071:Oxaloacetates; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D005472:Fluorouracil