Drug-induced myelosuppression : diagnosis and management

Myelosuppression is a common and anticipated adverse effect of cytotoxic chemotherapy. It is a potential but rare idiosyncratic effect with any other drug, but there is a recognised association with a number of higher-risk agents which justify additional vigilance. Genetic risk factors are being identified which may predispose individuals to this reaction with particular drugs. As marker tests become available, dose adjustment or alternative treatment choices may help to avoid more severe reactions. Myelosuppression is potentially life threatening because of the infection and bleeding complications of neutropenia and thrombocytopenia. Strategies for monitoring, early detection, diagnostic confirmation and appropriate supportive care are well developed for cytotoxic therapy. Developments in antimicrobial chemotherapy, blood product transfusion support and growth factor therapy have improved outcomes. These advances are largely applicable to idiosyncratic drug-induced myelosuppression, reinforcing the importance of early recognition and referral to appropriate expertise. Many reactions will resolve on drug withdrawal with appropriate supportive care during the period of cytopenia. Prolonged marrow failure may require more specific treatment with intensive immunosuppression or consideration of bone marrow transplantation.