Changes of Granulopoiesis during and after Adjuvant Chemotherapy of Breast Cancer

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Abstract
Adjuvant chemotherapy allows the study of effects of cytotoxic drugs on natural human hematopoiesis. Serial studies of granulopoiesis performed during and after intermittent adjuvant chemotherapy for breast cancer (adriamycin plus cyclophosphamide, given for 6 courses at monthly intervals) are described. After drug administration, a sequential wave of depletion and regeneration through successive granulopoietic compartments was observed. With repeated chemotherapy, moderate neutropenia developed, and the blood CFU-C [granulocytic progenitor cell] pool size became progressively reduced. After the 6th chemotherapeutic course, granulopoietic regeneration was delayed. Following discontinuation of chemotherapy, a long-lasting (> 200 days) reduction of the blood CFU-C pool size, together with neutropenia and reduction of marrow segmented neutrophils, was observed, suggesting a defect of granulopoiesis with persistent granulopoietic hypoplasia. In patients with expected long survival, residual bone marrow damage should be added to the list of potential late side effects of cytotoxic drug therapy.