Myelosuppression, also known as bone marrow suppression, is a common side effect of chemotherapy. It refers to decreased activity in the bone marrow, which results in fewer red and white blood cells and platelets.

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Individuals may develop myelosuppression as a result of blood-related cancer or as a side effect of some cancer treatments, such as chemotherapy, radiation therapy, and steroids. Some viruses, such as HIV, and certain medical conditions, including myelofibrosis, can also suppress the bone marrow’s function.

This article explores myelosuppression in more detail, including its causes, diagnosis, and treatment.

Myelosuppression describes the disrupted function of stem cells in the bone marrow. The bone marrow is responsible for making red and white blood cells and platelets.

As the bone marrow cannot function as it usually does, a person with myelosuppression may develop blood disorders, such as anemia, neutropenia, and thrombocytopenia. All of these blood disorders result from fewer red and white blood cells and platelets.

If myelosuppression is severe, a doctor may use the term myeloablation.

Myelosuppression is a common side effect of chemotherapy.

Myelosuppression occurs with chemotherapy because chemotherapy agents kill or slow down rapidly dividing cells. Although this treatment targets cancer cells, it also affects healthy bone marrow cells.

Learn more about the side effects of chemotherapy.

Some common chemotherapy drugs that may cause myelosuppression are:

  • Fluorouracil: This drug can cause all forms of myelosuppression.
  • Oxaliplatin: This medication can cause neutropenia and thrombocytopenia.
  • Irinotecan: This agent can lead to neutropenia.
  • Capecitabine: This medication can cause all forms of myelosuppression.

The most common cause of myelosuppression is medications that slow the ability of stem cells and specialized descendants to divide and multiply. This form of myelosuppression typically resolves when the individual stops using the medication.

Other possible causes include:

Cancer

Bone marrow cancer affects how the bone marrow functions, which can lead to myelosuppression.

Bone marrow cancers include:

Although it is more rare, myelosuppression can also occur when cancers of solid organs spread to the bone marrow.

Cancer treatment

Chemotherapy commonly causes myelosuppression, which can also occur as a result of antibiotics, such as piperacillin-tazobactam. Other cancer treatments, such as radiation therapy and steroids, can also affect an individual’s bone marrow.

Other causes

People may develop myelosuppression as a result of nutritional deficiencies and viruses such as HIV.

Additionally, some rare disorders, including primary myelofibrosis, can cause scarring in the bone marrow that affects how it functions.

The symptoms that a person with myelosuppression may experience will depend on the particular type of blood disorder. However, myelosuppression does not hurt.

Anemia

Anemia, which is a low number of red blood cells, is a condition that can cause the following symptoms:

Learn more about anemia.

Leukopenia

Leukopenia is a low white blood cell count. Without adequate white blood cells, the body will find it more difficult to fight infections.

The symptoms of leukopenia include:

Learn more about leukopenia.

Thrombocytopenia

Low platelets, called thrombocytopenia, can cause the following symptoms:

Learn more about thrombocytopenia.

Healthcare professionals may approach the diagnosis of myelosuppression differently depending on its likely cause. For example, if a person is receiving chemotherapy, a doctor may not need to perform tests to diagnose this condition.

However, in other cases, doctors may need to order tests such as blood analysis, bone marrow aspiration, and bone marrow biopsy.

A blood analysis involves taking a blood sample and checking for any abnormalities in blood cell counts.

A bone marrow aspiration and bone marrow biopsy require a doctor to take a small sample of bone and bone marrow, typically from the hip bone.

Learn more about what to expect from a bone marrow biopsy.

Healthcare professionals may recommend other tests before confirming a diagnosis.

The treatment of myelosuppression depends on the cause.

In the case of chemotherapy-induced myelosuppression, an individual’s blood cell counts begin to drop 7–10 days after they begin chemotherapy. If the blood cell counts become dangerously low, doctors may reduce or stop chemotherapy to allow the bone marrow to recover.

A doctor may also recommend transfusions to replenish red blood cells and platelets. People may require multiple treatments, as the effects are temporary.

In some cases, doctors may prescribe growth factor injections. These medications are similar to the chemicals that the body produces to stimulate the bone marrow to produce more of each cell type. There are different kinds of growth factors that can target red blood cells, white blood cells, or platelets. This treatment may decrease the need for transfusions and speed cell count recovery.

In some cases, doctors may recommend a bone marrow transplant. Healthcare professionals are likely to suggest this treatment if a person’s bone marrow becomes irreparably damaged.

Lifestyle changes

Doctors may also recommend several lifestyle adjustments if a person has mild myelosuppression that does not require treatment. These may include:

  • avoiding strenuous activities
  • performing low impact exercise
  • avoiding food that may injure the mouth and lead to bleeding
  • abstaining from alcohol use
  • washing the hands frequently to avoid infection
  • following a high protein diet
  • staying hydrated
  • avoiding shaving the arms, legs, and face
  • taking multivitamins or folic acid, in cases of nutritional deficiencies

Myelosuppression is not usually life threatening in itself, but if a person has fewer white blood cells, they have an increased risk of developing a potentially life threatening infection or bleed.

People should always discuss the potential risks of developing myelosuppression with a doctor before undergoing chemotherapy. They should also discuss the other side effects that they may experience during treatment.

In the case of chemotherapy-induced myelosuppression, doctors may reduce or temporarily stop chemotherapy to allow the bone marrow to recover. They may also recommend transfusions or other treatments.

Once an individual has completed chemotherapy, their blood cell counts typically return to baseline within a few weeks. However, in rare cases, chemotherapy can cause irreparable damage to the bone marrow. A doctor may recommend a bone marrow transplant in these cases.

Myelosuppression or bone marrow suppression means that the bone marrow produces fewer blood cells. It is a common side effect of chemotherapy, although it can be a result of other conditions, such as viruses and other health conditions.

People with myelosuppression may experience anemia, an increased risk of contracting infections, and easy bruising and bleeding.

The treatment of myelosuppression depends on the underlying cause, but in the case of chemotherapy-induced myelosuppression, doctors can reduce or delay cancer treatment. Typically, myelosuppression resolves when an individual finishes their chemotherapy regimen.