Neutropenia is a serious complication that can occur in cancer patients treated with chemotherapy, due to the ability of the drugs used to interfere with the activity of the bone marrow and, therefore, with the production of blood cells.

Neutropenia essentially consists in the reduction of the number of neutrophils (a type of white blood cells, also called granulocytes) in the blood below 500 / mm3, a value that represents the safety threshold to guarantee the body sufficient immune defences (normal levels of neutrophils in healthy people are between 1,500 and 8,000 / mm3).

The patient who develops neutropenia therefore experiences a "collapse" of the immune system and becomes vulnerable to any type of infection (bacterial, viral or fungal / yeast like Candida).

Furthermore, by considerably weakening the organism, neutropenia often obliges doctors to reduce the dosage of the chemotherapy treatment or to delay their administration compared to the times set by the treatment scheme, with the risk of compromising the anticancer efficacy and / or the possibility of completing therapy.

Febrile neutropenia

Febrile neutropenia (FN) corresponds to a rise in body temperature over 38.5 ° C for more than an hour or to a temperature of 38 ° C in three consecutive measurements one hour apart from other, associated with a persistent reduction in the number of neutrophils < 500 / mm3.

FN is a much feared complication of chemotherapy as it is associated with high morbidity and mortality, as well as significant additional management costs for the National Health Service (NHS). In about one in ten cases, FN leads to the development of septicaemia, bronchopneumonia, urethritis or other infections with fatal outcome.


The main manifestation of FN is the onset of fever, which may be accompanied by symptoms:

Linked to the presence of an infection

(fatigue, headache, lowering of blood pressure, etc.)

In a specific organ

(for example, respiratory and cough disorders in case of pneumonia, abdominal pain and diarrhoea in case of intestinal infection)

Related to the treatment that caused neutropenia


The diagnosis of FN is based on the detection of fever and a state of neutropenia (levels of neutrophils in the blood <500 / mm3) ascertained through laboratory investigations (blood count), in patients undergoing chemotherapy.

After the diagnosis of FN, the doctor may request in-depth investigations to identify the exact cause of the fever and set up a targeted treatment to eliminate it. In particular, it may be necessary to perform blood and biologic fluid tests to highlight the presence of pathogenic bacteria or fungi / yeasts and identify them, but also an X-ray or CT scan of the chest or an ultrasound of the abdomen, in order to evaluate the state of the internal organs most frequently affected by infections in the case of neutropenia.

Prevention and treatment

Thanks to the availability of biological drugs it is now possible to treat neutropenia and prevent the onset of its most serious complication, febrile neutropenia. This allows to increase the chances of completing chemotherapy, according to the established doses and times, maximizing the antitumor efficacy.

The guidelines for the treatment of neutropenia include the use of recombinant granulocyte growth factors (rG-CSF), which play a key role in the survival, multiplication and maturation of neutrophil granulocytes. These drugs stimulate the production of mature granulocytes by the bone marrow and promote their transfer from the blood to the tissues where, together with other cells of the immune system, they defend the body. The need to administer rG-CSF for the prevention of febrile neutropenia is evaluated by the doctor based on the patient's risk of developing the complication.

The available rG-CSF growth factors are:

  • short-acting, characterized by a short-term action, to be administered daily;
  • long-acting, characterized by a prolonged action, to be administered only once for each cycle of chemotherapy.