Higher Leukocyte Nadirs with Lithium Carbonate After Chemotherapy

Abstract

Leukocytosis has been observed following lithium carbonate administration in manic-depressive disorders (Mayfield et al.; 1966; O’Connell et al., 1970; Murphy et al., 1971). The elevation of the white blood count is modest, reversible, independent of blood lithium concentration, and due to neutrophilia (Murphy et al., 1971; Shopsin et al., 1971; Watanabe et al., 1974; Bille et al., 1975; Perez-Cruet et al., 1978, Yassa et al., 1978). Lithium may stimulate adrenocortical activity (Platman and Fieve, 1968; Shopsin and Gershon, 1971). It enhances marrow proliferation, elevates neutrophil production and increases the granulocyte pool without affecting granulocyte function or inhibiting neutrophil migration into skin lesions (Tisman et al., 1973; Rossof and Coltman, 1976; Malloy et al., 1978; Rothstein et al., 1978; Shenkman et al., 1978; Stein et al., 1978; Cohen et al., 1979; Steinherz and Smithwick, 1979). The mechanism by which lithium exerts its effect in vivo is unclear; however, it stimulates the formation of granulocytic colonies in the agar culture system either by stimulating the synthesis of colony stimulating factor (Harker et al., 1977) or by enhancing the action of colony stimulating factor (Morley and Galbraith, 1978). Increase in leukocyte numbers has also been observed with lithium treatment in patients with neutropenia secondary to Felty’s syndrome or aplastic anemia, and in congenital and acquired neutropenia (Gupta et al., 1975; Gupta et al., 1976; Barrett et al., 1977; Blum et al., 1979; Chan et al., 1979; deAlarcon et al., 1979). Reports of improved counts after cancer chemotherapy in small trials (Tisman, 1974; Greco and Brereton, 1977; Charron et al., 1977; Catane et al., 1977; Stein et al., 1977; Tiefenbach et al., 1977; Steinherz et al., 1979a) prompted us to evaluate lithium carbonate after chemotherapy in a randomized, paired, prospective study (Steinherz et al., 1979b.).