Grade 3 and 4 Chemotherapy-Induced Neutropenia in Patients Followed at a Referral Hospital in Cameroon

Abstract

Introduction: Cancer is a growing global health concern, but advances in early diagnosis and therapeutic modalities, particularly chemotherapy, have led to a decline in mortality. Despite their efficacy, cytotoxic agents are associated with hematological toxicities, most notably neutropenia. Grade 3 and 4 neutropenia carries a high risk of infectious complications, which can compromise the optimal delivery of chemotherapy protocols. To maintain effective treatment regimens, scientific societies recommend the use of granulocyte colony-stimulating factors (G-CSFs). While their benefit in managing neutropenia is well-documented, their use requires a thorough understanding of the patient, their cancer, and the specific chemotherapy regimen being administered. This study aims to describe the sociodemographic, clinical, therapeutic, and evolutionary characteristics of patients with chemotherapy-induced grade 3 and 4 neutropenia at the Yaoundé General Hospital. Methods: We conducted a cross-sectional, retrospective study in the oncology department of the Yaoundé General Hospital over a 10-month period, from November 1, 2022, to August 31, 2023. Our study population consisted of cancer patients aged 18 years or older who had received at least one chemotherapy cycle and experienced at least one episode of grade 3 or 4 neutropenia. Patients with incomplete medical records or those receiving concomitant neutropenia-inducing medications were excluded. We used a consecutive, non-probabilistic, and exhaustive sampling method for retrospective data collection. The variables studied included sociodemographic and clinical characteristics, therapeutic management, and patient outcomes. Results: A total of 93 patients were included, representing 157 episodes of grade 3 and 4 neutropenia. The population was predominantly female (82%), with a mean age of 48.42 years ± 12.1 years. Breast cancer was the most common malignancy (53.8%), and the majority of patients (50.5%) had metastatic disease. The AC 60 protocol was the most frequent regimen associated with grade 3 and 4 neutropenia (54.7%). Most patients (80%) had a WHO performance status of 1, and 7.5% developed febrile neutropenia. All episodes of grade 3 and 4 neutropenia led to a postponement of the chemotherapy cycle, while filgrastim was administered in 24.2% of cases. At the 7-day follow-up, complete blood count (CBC), the neutropenia had resolved in 86% of the episodes. Conclusion: Chemotherapy-induced grade 3 and 4 neutropenia is a frequent reason for chemotherapy delays, thus hindering the optimal administration of treatment regimens. These findings highlight the importance of improving the management of this complication to enhance the efficacy of cancer treatment in this setting.