Some Haematological Parameters of Cancer Patients on Cytotoxic Therapy After Surgery

Abstract

Alterations in coagulation system and immune cells in cancer patients are exacerbated by chemotherapy. The aim of this study was to assess the effects of cytotoxic therapy on haematological parameters in cancer patients in Edo State as well as evaluating the different
chemotherapeutic effects of the various drug combinations. Adequate and systematic monitoring of patients’ haematological parameters during and after chemotherapy is necessary. A total of one hundred and one (101) patients with various histologically
diagnosed malignancies who had undergone surgical treatment and booked for chemotherapy in Central (Specialist) Hospital and Ohize Medical Centre in Benin City were selected for this study. The socio-demographic data of the patients were assessed using questionnaires. Ten millimeters (10mls) of blood samples were collected from each patient by vene-puncture before the commencement of chemotherapy (day 0) and during the first cycle of treatment. CD4 lymphocyte count was estimated by flow cytometric analysis; absolute neutrophil count (ANC) and platelet count (PLT) by Sysmex KX-2IN auto analyzer, fibrinogen concentration (FIB) by Ingram’s clot weight method, prothrombin time (PT) and activated partial thromboplastin time (APPT) were done by Dacie delineated method. The patients’ ages ranged from thirty – five (35) to seventy – four (74) years. There were twenty-eight 28 (27.7%) males and seventy-three 73 (72.3%) females. Among whom were patients with breast cancer (68.3%), colorectal carcinoma (20.8%) and other cancers (10.9%). Out of the one hundred and one (101) cases, fifty-eight 58 (57.4%) of the patients presented in the early stage of their malignancies while 43 (42.6%) of them presented with advanced cancers. The overall post-chemotherapy mean CD4 lymphocyte count, ANC, FIB, and PLT reduced significantly when compared with their respective pre-chemotherapy means (p<0.01). The post-chemotherapy mean PT and APTT values prolonged significantly when compared with
the pre-chemotherapy mean values respectively (p<0.01). Also, the post-chemotherapy mean CD4 lymphocyte values, ANC, FIB, PLT, of patients with breast cancer, colorectal carcinoma and other malignancies (anorectal and cystadenocarcinoma) reduced significantly
while their mean PT and APTT values were prolonged significantly when compared with the respective pre-chemotherapy mean values (p<0.05). However, there was no significant decrease in the pre- and post- chemotherapy mean FIB values of patients with other
malignancies (p>0.05). Also, post- chemotherapy levels of CD4 lymphocyte, ANC, PLT, FIB, PT and APTT levels of patients on combinations therapy and single agent therapy differed significantly with their respective pre-chemotherapy mean values (p<0.05).
However, there were no significant reductions in the PLT levels of those on cyclophosphamide, methotrexate and 5-fluorouracil (CMF), as well as those who were given 5-fluorouracil and leucovorin (FL) (p>0.05). Although, the post-chemotherapy mean PLT and FIB levels of patients who received 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and those on single agent therapy were lower but did not differ significantly with their respective pre-chemotherapy mean values (p>0.05). Generally, significant reduction was seen in the post-chemotherapy mean PLT and FIB levels of all the patients who received the various combinations therapy protocol compared with the pre-chemotherapy mean values (p<0.01). Whereas, no significant reductions were recorded in the post- chemotherapy means PLT and FIB values of all patients who received single agent therapy (p>0.05). Chemotherapeutic regimens have been found to cause marked significant depletion of CD4 lymphocyte of patients leading to CD4 lymphopenia which can predispose these patients to opportunistic infections. CD4 lymphocyte count is a more useful and appropriate marker of immune suppression than ANC within the first cycle of post-chemotherapy course. The prolonged PT and APTT, as well as the reduction in FIB concentration observed in this study can predispose cancer patients on chemotherapy to bleeding tendency. Similarly, combination
chemotherapy protocols have more significant toxic effects on platelet and fibrinogen than single agent therapy and epirubicin combination therapy appears to be less immuno-toxic than Adriamycin combination protocol. The prefered use of epirubicin combination protocol to Adriamycin in breast cancer patients should be further validated to help improve on the quality of life, survival and reduce deaths arising from complications in patients due to chemotherapy treatment.