Chemotherapy-Induced Myelosuppression in Patients With gBRCA-m Epithelial Ovarian Cancer: A Retrospective Study

Existing evidence indicates that germline BRCA mutation (gBRCA-m) may increase chemotherapy sensitivity and toxicity. However, its role in chemotherapy-induced myelosuppression (CIM) remains unclear. We conducted this study to investigate the influence of gBRCA-m on CIM incidence and severity in patients with epithelial ovarian carcinoma (EOC).

Patients with EOC treated at the First Affiliated Hospital of Nanjing Medical University from January 2018 to August 2023 were classified into two groups: gBRCA-m and gBRCA wild-type. Chemotherapy regimen and myelosuppression data were retrospectively reviewed. Multivariate analysis assessed the association between gBRCA-m and CIM incidence and severity in patients with EOC receiving first-line chemotherapy.

Sixty six (27%) of 242 included patients were gBRCA-m carriers. The median times to myelosuppression onset and the most severe occurrence were significantly shorter for patients with gBRCA-m (6.0 vs. 27.0 days, p < 0.001; 73.5 vs. 121.0 days, p < 0.001). Patients with gBRCA-m had a greater likelihood of Grade IV (GIV) myelosuppression at onset (aOR = 5.585, 95% CI = 1.621-19.241). During the most severe myelosuppression, patients with gBRCA-m experienced more pronounced decreases in white blood cells (1.83 × 10⁹ vs. 2.33*10⁹ cells/L, p = 0.002), neutrophils (0.73 × 10⁹ vs. 1.08 × 10⁹ cells/L, p = 0.001), haemoglobin levels (90.41 vs. 94.14 g/L, p = 0.017) and platelets (81.62 × 10⁹ vs. 97.63 × 10⁹ cells/L, p = 0.001) and were more prone to febrile GIV myelosuppression (aOR = 2.882, 95% CI = 1.071-7.754). The incidences of chemotherapy dose reduction (aOR = 4.322, 95% CI = 2.048-9.124) and delay (aOR = 6.045, 95% CI = 2.266-16.126) were significantly greater in patients with gBRCA-m. An analysis across all chemotherapy cycles indicated that patients with gBRCA-m had greater risks of GIII (aOR = 2.356, 95% CI = 1.770-3.137), GIV (aOR = 2.324, 95% CI = 1.685-3.207) myelosuppression and GIV myelosuppression with fever (aOR = 2.097, 95% CI = 1.077-4.083), as well as a greater incidence of chemotherapy dose reduction (aOR = 2.606, 95% CI = 1.785-3.805) and delay (aOR = 4.118, 95% CI = 2.213-7.663).

EOC patients with gBRCA-m experienced earlier and more severe CIM, highlighting the need for careful monitoring and tailored management.