Neutropenia
A shortage of neutrophils, the white blood cells that fight bacteria, caused by chemotherapy hitting the bone marrow. It usually bottoms out (the nadir) 7-14 days after each cycle and recovers before the next; while low, infection risk is high.
The commonest dose-limiting toxicity of cytotoxic chemotherapy and of many targeted drugs (CDK4/6 inhibitors, PARP inhibitors, sacituzumab govitecan) and cell therapies. Graded by absolute neutrophil count (grade 3 <1.0, grade 4 <0.5 × 10⁹/L); severity and duration determine infection risk and febrile neutropenia. Managed by dose delays and reductions, prophylactic G-CSF, and for some drugs (palbociclib) simply tolerated because it is uncomplicated. Trilaciclib protects marrow during chemotherapy in small-cell lung cancer. Prolonged cytopenias after CAR-T (ICAHT) and after lymphodepletion are distinct in mechanism and can last months.
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