Bone marrow suppression also known as myelotoxicity or myelosuppression , is a decrease in cell production responsible for providing immunity (leukocytes), carrying oxygen (erythrocytes) , and/or those responsible for normal blood clotting (platelets). Bone marrow suppression is a serious side effect of chemotherapy and certain drugs that affect the immune system such as azathioprine. The risk is very high in cytotoxic chemotherapy for leukemia.
Nonsteroidal anti-inflammatory drugs (NSAIDs), in some rare cases, can also cause bone marrow suppression. A decrease in the number of blood cells does not occur right at the beginning of chemotherapy because drugs do not destroy the cells that already exist in the bloodstream (this does not divide rapidly). Instead, drugs affect new blood cells made by the bone marrow. When myelosuppression is severe, it's called myeloablation.
Many other drugs include common antibiotics that can cause bone marrow suppression. Unlike chemotherapy, the effect may not be due to direct stem cell destruction, but the results may be just as serious. Treatment may reflect chemotherapy-induced myelosuppression or may turn into alternative medicine or temporarily halt treatment.
Since the bone marrow is the center of the production of blood cells, suppression of bone marrow activity causes a lack of blood cells. This condition can quickly lead to life-threatening infections, as the body can not produce leukocytes in response to bacterial and viral attacks, as well as cause anemia due to lack of red blood cells and spontaneous severe bleeding due to platelet deficiency.
Parvovirus B19 inhibits erythropoiesis by RBC precursors that infect the spleen in the bone marrow and is associated with a number of different diseases ranging from benign to severe. In immunocompromised patients, B19 infection can persist for months, leading to chronic anemia with B19 viremia due to chronic marrow suppression.
Video Bone marrow suppression
Treatment
Bone marrow suppression due to azathioprine can be treated by replacing to other drugs such as mycophenolate mofetil (for organ transplant) or other disease-modifying drugs in rheumatoid arthritis or Crohn's disease.
Chemotherapy induces myelosuppression
Bone marrow suppression due to anti-cancer chemotherapy is much more difficult to treat and often involves hospitalization, strict infection control, and the use of aggressive intravenous antibiotics in the first sign of infection.
G-CSF is used clinically (see Neutropenia) but tests in mice suggest it can cause bone loss.
GM-CSF has been compared with G-CSF as a treatment of myelosuppression/Neutropenia induced by chemotherapy.
Maps Bone marrow suppression
Prediction
In developing new chemotherapy, the efficacy of the drug against the disease is often offset by the possible level of drug mielotoxicity that will cause it. In-vitro colony forming cell (CFC) tests using normal human bone marrow grown in appropriate semi-solid media such as ColonyGEL have proven useful in predicting clinical myelotoxicity levels that may be caused by certain compounds if administered to humans. These in-vitro predictive tests reveal the effects of compounds administered to bone marrow progenitor cells that produce various mature cells in the blood and can be used to test the effects of a single drug or drug effect given in combination with another.
See also
- Hematopoietic stem cell transplant
- Neutropenia, low leukocyte
References
Source of the article : Wikipedia
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