5 points you should master to prevent chemotherapy leukopenia More and more tumors are treated with concurrent radiotherapy, and the toxic side effects of concurrent radiotherapy are getting more and more attention, especially the toxic side effect of myelosuppression. Clinically, it is often observed that due to the myelotoxicity of radiotherapy, the leukocytes are still very low at the time of chemotherapy expiration, and the granulocyte colony-stimulating factor (GCSF) can be raised. However, the question that arises is: Can chemotherapy be given immediately after GCSF raises the white blood cells? Some people say that we should rest for 48 hours to review and if it is normal, chemotherapy can be given. However, after 48 hours, many patients’ white blood cells have dropped again, so they need to raise their white blood cells again, and chemotherapy is postponed again and again. 1. whether to use GCSF prophylactically before chemotherapy ASCO guidelines: prophylactic use of GCSF in non-primary patients is only used for patients who develop granulocyte deficiency comorbidities (such as fever) after the previous course (no prophylactic use of GCSF) and the reduction of the dose may affect the efficacy of the treatment. The risk is 10-20% and can be considered as intermediate risk. See NCCN guidelines for specific evaluation criteria. The recurrence rate is 50-60% after the next chemotherapy for patients who have had granulocyte deficiency comorbidities. Preventive use of GCSF may reduce the risk by 50%. In summary, patients with solid tumors who have not experienced granulocyte comorbidities and have no high-risk factors should not use GCSF prophylactically. 2. Timing of GCSF use in chemotherapy Many papers report that GCSF is best applied 24-48 hours after chemotherapy. The drug should be stopped before the next chemotherapy and not used on the day of chemotherapy. The increase in leukocytes after GCSF application is bimodal: the first peak is 2-3 days after the application of GCSF, then drops to the lowest level 5-6 days later, and then increases again, reaching the second peak 8-9 days later. The first peak is the result of GCSF promoting the peripheral release of mature granulocytes already present in the bone marrow blood pool. The second peak is the result of GCSF stimulating the proliferation and differentiation of bone marrow granulopoietic progenitor cells and releasing them into the peripheral blood. 3. The duration of drug administration should not be less than 3 days. Too short a period of time can only cause the first peak, and stopping the drug leukocytes easily drop to the lowest point and easy to appear infection, fever. Why can’t I use it on the day of chemotherapy? The neutrophils produced by stimulation will be destroyed by chemotherapy drugs, which will aggravate its damage to the bone marrow reserve function and increase the risk of moderate bone marrow suppression. 4. Toxic side effects Local pain, weakness, fever, muscle aches and pains. Patient education and explanation should be done in advance. 5. Precautions 1. Timely review of blood routine and adjustment of treatment plan Generally speaking, chemotherapy can be administered 24 hours after normal blood check after whitening. After 24 hours after the first cycle of chemotherapy, it is necessary to routinely prevent leukostasis for 3 days, and then review the blood routine and consider continuing leukostasis or reviewing the blood routine again after a week according to the results of the review. If, after the prophylactic leukostasis in the first cycle of chemotherapy, the routine blood test before the second cycle of chemotherapy is still IV degree myelosuppression, then the subsequent chemotherapy should be given at 75% of the original dose. In case of granulocyte deficiency fever, chemotherapy should be administered before the next cycle with leukocyte boosting prophylaxis. 2. use of shiitake mushroom polysaccharide Some literature reports that shiitake mushroom polysaccharide is beneficial to improve bone marrow hematopoietic function, and its instructions state that occasional reduction of red and white blood cells and hemoglobin is seen, indicating that shiitake mushroom polysaccharide has minimal hematologic suppression. 3. Carefully fill out the patient’s discharge record and notes in detail The discharge notes clearly state which day to start raising white blood cells and for how many days, and which day to check blood, and have the patient report the results to the physician in a timely manner. If the patient is only verbally told which day to start raising white blood cells, the patient’s compliance will be very poor and it will be too late when degree IV myelosuppression occurs. In addition, the discharge summary must state that the patient is not well enough to follow up.