Temporal Hematologic Alterations in Women Receiving Pharmacotherapy for Breast Cancer: A Prospective Analysis

Breast cancer pharmacotherapy commonly results in hematologic toxicity and systemic inflammatory shifts that may compromise treatment tolerance. This study evaluated baseline hematologic characteristics and early hematologic changes following pharmacotherapy among patients treated in second-referral centers in Indonesia.

This prospective cohort study enrolled 106 women with confirmed breast cancer between January and October 2025. Hematologic evaluations were performed before treatment and at Weeks 1 and 3. Assessed parameters included hemoglobin, leukocyte and platelet counts, differential counts, the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and the pan-immune-inflammation value (PIV). Friedman's two-way analysis of variance by ranks was used for pre-post comparisons. Subgroup comparisons between survivors and non-survivors used Mann-Whitney U tests.

The mean age was 51.9 ± 9.7 years, with most patients presenting with locally advanced disease (58.5%) and invasive ductal carcinoma (84%). Baseline hemoglobin averaged 11.9 g/dL and leukocyte count 7.5 × 10³/µL. Marked hematologic suppression occurred after therapy: leukocyte and absolute neutrophil counts declined significantly at week 1 with partial recovery by week 3 (p <0.001). Inflammatory indices showed substantial fluctuations, with significant changes in PLR, MLR, and PIV (all p <0.001). Anemia increased from 51.9% at baseline to 74.0% post-therapy. Neutropenia occurred in 1.9% at baseline, 41.7% at week 1, and 1.1% at week 3. Among survival subgroups, only MLR differed significantly (p = 0.043).

The mean age was 51.9 ± 9.7 years, with most patients presenting with locally advanced disease (58.5%) and invasive ductal carcinoma (84%). Baseline hemoglobin averaged 11.9 g/dL and leukocyte count 7.5 × 10³/µL. Marked hematologic suppression occurred after therapy: leukocyte and absolute neutrophil counts declined significantly at week 1 with partial recovery by week 3 (p <0.001). Inflammatory indices showed substantial fluctuations, with significant changes in PLR, MLR, and PIV (all p <0.001). Anemia increased from 51.9% at baseline to 74.0% post-therapy. Neutropenia occurred in 1.9% at baseline, 41.7% at week 1, and 1.1% at week 3. Among survival subgroups, only MLR differed significantly (p = 0.043).