Leukoprotection

Leukoprotection is the set of medical strategies aimed at preserving or protecting leukocytes, particularly neutrophils, during exposure to cytotoxic therapies or other insults that threaten white blood cell counts. The goal is to reduce the risk of infection, allow cancer treatments to proceed as planned, and shorten interruptions in therapy.

The mainstay of leukoprotection is pharmacologic augmentation of leukopoiesis. Granulocyte colony-stimulating factors (G-CSFs) such as filgrastim and the longer-acting pegylated form, pegfilgrastim, stimulate bone marrow to produce neutrophils and accelerate recovery after chemotherapy. Granulocyte-macrophage colony-stimulating factors (GM-CSFs) are also used in some settings. Amifostine and other cytoprotective agents have been explored to shield normal tissues, including bone marrow, from radiation or chemotherapy, though their use is more limited. Supportive care measures, including dose modifications, antimicrobial prophylaxis, and prompt treatment of infections, also contribute to leukoprotection.

Indications include many cytotoxic regimens for solid tumors and hematologic malignancies, autologous stem cell transplantation, and radiotherapy when neutropenia is anticipated. Benefits include reduced duration and severity of neutropenia, lower risk of febrile neutropenia, fewer infections, and the ability to maintain planned treatment schedules. Risks include bone pain, injection-site reactions, leukocytosis, rare splenic adverse events, and higher treatment costs. Additionally, theoretical concerns exist about stimulating tumor growth in certain cancers, underscoring the need for risk-based use.

Guidelines generally recommend G-CSF prophylaxis for regimens with a high risk of febrile neutropenia and consider it for intermediate risk when patient factors add to risk.