Clinical Management of Marrow Suppression and Immune Suppression

Abstract

Marrow suppression and immune suppression commonly accompany cancer. They are most frequently observed in the leukemias and other diseases associated with replacement of the marrow and in primary malignant diseases of the immune system. In addition “solid” tumors or non-hematologic malignancy may metastasize to the bone marrow replacing normal elements. Finally, treatment directed at the tumor may incidentally affect production of cells. Bone marrow suppression is associated with the secondary development of anemia, leukopenia, or thrombocytopenia. Peripheral and central depletion of the “formed elements” of the blood—that is, the red blood cells, white blood cells, and platelets—leads to anemia, and can bring about infection and/or bleeding. Immune suppression may be distinguished from marrow suppression in that the cells involved in the immune system are lymphocytes and plasma cells. Furthermore, the depletion of these elements may only be evaluated by specific tests, such as immunoglobulin analysis and the lymphocyte function tests. The management of marrow suppression and immune suppression is one of the most delicate clinical issues because the common causes of mortality in cancer result from secondary sepsis or hemorrhage. This chapter will focus on the management of anemia, leukopenia, and thrombocytopenia in the patient with neoplastic disease and also on the management of chemotherapy in patients with secondary marrow and immune suppression.