Management of hematologic and infectious complications of intensive induction therapy for small cell carcinoma of the lung

Abstract

In an effort to improve response rate and survival in small cell carcinoma of the lung, considerable attention has been focused on induction therapy with intensive chemotherapeutic regimens. The morbidity and mortality of such therapeutic programs have been of considerable concern. The hematologic and infectious complications of highly intensive induction chemotherapy in 72 patients with small cell lung cancer treated at the Johns Hopkins Oncology Center were reviewed, and guidelines for the management of aplasia in this patient population are suggested. Bone marrow aplasia was severe, with 90 percent of 140 cycles of therapy associated with the development of fever. However, during only 20 percent of febrile episodes could a specific site of infection or pathogen be identified. Prophylactic platelet transfusions were administered during 42 percent of courses because of severe thrombocytopenia (platelet count below 20,000/mm 3). Only a single significant bleeding episode developed during therapy. The occurrence of bacteremia (9.3 percent of cycles) was strongly associated with the development of severe thrombocytopenia. There were no deaths during aplasia. It is concluded that intensive combination chemotherapy can be safely administered to this elderly patient population with acceptable morbidity provided there is strict adherence to the unique principles of antibiotic usage and platelet support during bone marrow aplasia.