Myelosuppression

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As myelosuppression , even myelodepression , bone marrow (s) depression or bone marrow (s) inhibition called, refers to the exposure of normal blood formation ( hematopoiesis ) in the bone marrow . In the English-language specialist literature , one speaks of bone marrow suppression or myelosuppression .

Effects

The suppression of blood formation leads to a deficiency in the organism

As a result of this deficiency, the immune system is considerably weakened, which among other things can lead to more frequent infections . The lack of blood platelets ( thrombocytes ) leads to an increased risk of bleeding . The anemia leads, among other things, to a drop in performance and rapid fatigue. Myelosuppression is potentially life threatening.

causes

Myelosuppression can be triggered by any factor that damages the bone marrow. These can be exogenous factors such as radiation therapy , radiation sickness and chemotherapy with cytostatics . Intolerance to drugs, such as metamizole , can also lead to myelosuppression via agranulocytosis . Endogenous factors that can lead to myelosuppression include immune thrombocytopenia and bone marrow carcinosis .

Various infectious agents can have a myelodepressive effect, in particular various viruses that can infect the stem cells directly, such as cytomegalovirus (affects stem cells of lymphopoiesis ) and parvovirus B19 (stem cells of erythropoiesis ).

Almost all cytostatics are myelosuppressive due to their myelotoxicity and limit the dose for many of these active substances. While the cancer cells become increasingly resistant to the cytostatics in the course of the therapy cycles, this is not the case with the blood-forming (haematopoietic) stem cells . Here the damage accumulates with each therapy cycle.

therapy

In chemotherapy, the simultaneous administration of haematopoietic growth factors such as granulocyte colony stimulating factor (G-CSF) can alleviate or shorten acute myelosuppression. The damage to the bone marrow caused by chemotherapy is almost always curable.

The complete elimination of stem cells in the bone marrow is called irreversible myeloablation . In certain cases it can be therapeutically necessary. A stem cell transplant can then restore the bone marrow.

further reading

  • L. Balducci: Myelosuppression and its consequences in elderly patients with cancer. In: Oncology (New York) Volume 17, Number 11 Suppl 11, November 2003, pp. 27-32, ISSN  0890-9091 . PMID 14682116 . (Review).
  • MB Maxwell, KE Maher: Chemotherapy-induced myelosuppression. In: Seminars in oncology nursing Volume 8, Number 2, May 1992, pp. 113-123, ISSN  0749-2081 . PMID 1621002 . (Review).
  • SM Grant, RC Heel: Recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF). A review of its pharmacological properties and prospective role in the management of myelosuppression. In: Drugs Volume 43, Number 4, April 1992, pp. 516-560, ISSN  0012-6667 . PMID 1377118 . (Review).

Individual evidence

  1. ^ PJ Carey: Drug-induced myelosuppression: diagnosis and management. In: Drug Safety Volume 26, Number 10, 2003, pp. 691-706, ISSN  0114-5916 . PMID 12862504 . (Review).
  2. ↑ J. Randolph-Habecker, M. Iwata, B. Torok-Storb: Cytomegalovirus mediated myelosuppression. Journal of Clinical Virology (2002) Volume 25 Suppl. 2, pp. S51-S56, ISSN  1386-6532 PMID 12361756 (Review)
  3. ^ LE Friberg, MO Karlsson: Mechanistic models for myelosuppression. In: Investigational New Drugs Volume 21, Number 2, May 2003, pp. 183-194, ISSN  0167-6997 . PMID 12889739 . (Review).
  4. ↑ a b H.-J. Schmoll, K. Höffken, K. Possingerl: Compendium of internal oncology standards in diagnostics and therapy. Edition 4, Verlag Springer, 2005, ISBN 3-540-20657-4 , p. 677. Limited preview in the Google book search
  5. ^ PJ Carey: Drug-induced myelosuppression: diagnosis and management. In: Drug safety: an international journal of medical toxicology and drug experience, Volume 26, Number 10, 2003, pp. 691-706, ISSN  0114-5916 . PMID 12862504 . (Review).

footnote

  1. ↑ Both spellings with and without fugue-s are widespread in the literature.