Association Between Chemotherapy Regimens and Neutropenia Severity Among Cancer Patients: A Cross-Sectional Study

• Elaf Ali Jamaluldeen

  Oncology Teaching Hospital, Medical City, Baghdad, Iraq.

• Aula Fadhil Alwan

  Baghdad Radiotherapy Center, Medical City, Baghdad, Iraq.

• Rasha Hassan Abdulhussein Al-Oraibi

  Aljawad Center, Kadhimiya Teaching Hospital, Baghdad, Iraq.

• Mohammed Kamil Al Qayyim

  Hematology and Transplant Center (HTC center), Medical City Complex, Iraq.

• Musaab Kadhim Alabboodi

  Alamal National Hospital for Cancer Treatment, Baghdad, Iraq.

Chemotherapy-induced neutropenia (CIN) is a prevalent and potentially severe complication in cancer patients, significantly increasing the risk of infection, treatment delays, and overall morbidity. Despite its clinical importance, there is a paucity of data regarding the patterns and severity of neutropenia in relation to specific chemotherapy regimens in diverse oncology settings. A cross-sectional study was conducted involving 98 cancer patients diagnosed with neutropenia following chemotherapy at three oncology centers in Iraq. The data were collected retrospectively from the patients' medical records and included demographic characteristics, the number of chemotherapy cycles at the onset of neutropenia, the severity of neutropenia, the status of chemotherapy continuation, and the specific treatment regimens administered. The association between chemotherapy regimens and severity of neutropenia was analyzed using chi-square tests. The majority of patients were female (68.4%) and over 50 years of age (75.5%). Hematological malignancies were predominant (81%). Neutropenia was most frequently observed during the second cycle of chemotherapy (47%) and was typically of moderate severity (68.4%). Notwithstanding the occurrence of neutropenia, the administration of chemotherapy was pursued in 70.5% of cases. The most frequently observed association between the regimen and neutropenia was the Hodgkin lymphoma protocol (doxorubicin, bleomycin, vinblastine, and dacarbazine), which accounted for 14.3% of cases and exhibited a significant association with the severity of neutropenia (p = 0.012). Furthermore, the analysis revealed statistically significant associations between specific regimens and both acute lymphoblastic leukemia (p = 0.031) and non-Hodgkin lymphoma (p = 0.044). This study underscores the critical need for regimen-specific risk assessment and individualized management strategies for neutropenia in cancer patients. The identification of high-risk regimens can inform proactive monitoring and supportive interventions, with the aim of minimizing complications and optimizing treatment continuity.

Abdul Rasool Hassan, B., Yusoff, Z. B. M., & Bin Othman, S. (2011). Association of neutropenia onset and severity with chemotherapy regimens and schedules. Asian Pacific Journal of Cancer Prevention : APJCP, 12(6), 1425–1428.

Al-Shammary, E., & Mohammed, D. (2020). Chemotherapy-induced neutropenia after initial and subsequent chemotherapy cycle of non-hodgkin lymphoma. Mustansiriya Medical Journal, 19(1), 16. https://doi.org/10.4103/MJ.MJ_4_20

Ba, Y., Shi, Y., Jiang, W., Feng, J., Cheng, Y., Xiao, L., Zhang, Q., Qiu, W., Xu, B., Xu, R., Shen, B., Luo, Z., Xie, X., Chang, J., Wang, M., Li, Y., Shuang, Y., Niu, Z., Liu, B., … Zhou, C. (2020). Current management of chemotherapy-induced neutropenia in adults: key points and new challenges. Cancer Biology and Medicine, 17(4), 896–909. https://doi.org/10.20892/j.issn.2095-3941.2020.0069

Bakirtas, M., Yiğenoğlu, T., Başci, S., Ulu, B., Yaman, S., Çakar, M., Dal, M., & Altuntaş, F. (2022). Febrile neutropenia risk factors in actively treated diffuse large B-cell lymphoma patients. Iraqi Journal of Hematology, 11(1), 7. https://doi.org/10.4103/ijh.ijh_37_21

Blayney, D. W., & Schwartzberg, L. (2022). Chemotherapy-induced neutropenia and emerging agents for prevention and treatment: A review. Cancer Treatment Reviews, 109, 102427. https://doi.org/10.1016/j.ctrv.2022.102427

Boccia, R., Glaspy, J., Crawford, J., & Aapro, M. (2022). Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed? The Oncologist, 27(8), 625–636. https://doi.org/10.1093/oncolo/oyac074

Ceken, S., Gedik, H., Iskender, G., Demirelli, M., Mert, D., Yapar Toros, G., Yigenoglu, T. N., Altuntas, F., Oksuzoglu, B., & Ertek, M. (2020). Evaluation of Risk Factors for Mortality in Febrile Neutropenia. The Journal of Infection in Developing Countries, 14(08), 886–892. https://doi.org/10.3855/jidc.12520

Dessalegn, M., Fantahun, M., Yesufe, A. A., Hussein, M., & Tsegaye, A. (2023). Chemotherapy Induced Neutropenia, Febrile-Neutropenia and Determinants Among Solid Cancer Patients Attending Oncology Unit of a Tertiary Care Teaching Hospital in Ethiopia. Cancer Management and Research, Volume 15, 185–195. https://doi.org/10.2147/CMAR.S386181

Dinakaran, A., Sultana, J., Fatima, M., Fatima, R., Suleman, S., Quadri, M., & Mohathasim Billah, A. A. (2023). A RETROSPECTIVE STUDY ON THE INCIDENCE OF CHEMOTHERAPY- INDUCED NEUTROPENIA AMONG CANCER PATIENTS. https://doi.org/10.13140/RG.2.2.32629.96487

Fioredda, F., Skokowa, J., Tamary, H., Spanoudakis, M., Farruggia, P., Almeida, A., Guardo, D., Höglund, P., Newburger, P. E., Palmblad, J., Touw, I. P., Zeidler, C., Warren, A. J., Dale, D. C., Welte, K., Dufour, C., & Papadaki, H. A. (2023). The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action. HemaSphere, 7(4), e872. https://doi.org/10.1097/HS9.0000000000000872

Gargiulo, P., Arenare, L., Gridelli, C., Morabito, A., Ciardiello, F., Gebbia, V., Maione, P., Spagnuolo, A., Palumbo, G., Esposito, G., Della Corte, C. M., Morgillo, F., Mancuso, G., Di Liello, R., Gravina, A., Schettino, C., Di Maio, M., Gallo, C., Perrone, F., & Piccirillo, M. C. (2021). Chemotherapy-induced neutropenia and treatment efficacy in advanced non-small-cell lung cancer: a pooled analysis of 6 randomized trials. BMC Cancer, 21(1), 549. https://doi.org/10.1186/s12885-021-08323-4

Jia, H., Liang, L., Chen, X., Zha, W., Diao, W., & Zhang, W. (2024). Predictive value of peri-chemotherapy hematological parameters for febrile neutropenia in patients with cancer. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1380195

Kirolos, N., Tang, K., & Abbott, L. S. (2023). Does age play a role in fever and neutropenia events and complications: A comparison of adolescents versus younger children with cancer at a tertiary care pediatric hospital, a pilot project. Cancer Reports, 6(4). https://doi.org/10.1002/cnr2.1767

Lone, T. M., Nadeem, M., Khan, A., Umair, M., Hamid, M., & Masood, M. (2024). Neutropenia: Frequency and Management Outcomes in Women with Breast Cancer Receiving Anthracycline Based Chemotherapy. Pakistan Armed Forces Medical Journal, 74(4), 901–905. https://doi.org/10.51253/pafmj.v74i4.7770

Min, K. Il, & Byeon, S. (2025). Diagnosis and management of neutropenia. Blood Research, 60(1), 30. https://doi.org/10.1007/s44313-025-00079-1

Morecroft, R., Logothetics, C. N., Tarnawsky, S. P., & Davis, A. A. (2024). Chemotherapy-induced neutropenia management in a patient with metastatic breast cancer and Shwachman-Diamond syndrome (SDS): a case report. Translational Breast Cancer Research, 5, 26–26. https://doi.org/10.21037/tbcr-24-13

Neesanun, S. (2022). Risk Factors Predicting Chemotherapy-induced Severe Neutropenia and Outcome in Advanced Stage Non-small Cell Lung Cancer: Data from the Limited Resource in Thailand. Asian Pacific Journal of Cancer Care, 7(2), 285–293. https://doi.org/10.31557/apjcc.2022.7.2.285-293

Salako, O., Sharafadeen Okunade, K., Adeniji, A. A., Fagbenro, G. T., & Afolaranmi, O. J. (2021). Chemotherapy induced neutropenia and febrile neutropenia among breast cancer patients in a tertiary hospital in Nigeria. Ecancermedicalscience, 15. https://doi.org/10.3332/ecancer.2021.1188

Sebastian, P., Kuruvadangal, A. M., & Babu, H. (2021). Incidence of neutropenic fever and sepsis in patients receiving induction chemotherapy in acute leukemia. International Journal of Research in Medical Sciences, 9(11), 3335. https://doi.org/10.18203/2320-6012.ijrms20214413

Straus, D. J., Johnson, J. L., LaCasce, A. S., Bartlett, N. L., Kostakoglu, L., Hsi, E. D., Schöder, H., Hall, N. C., Jung, S.-H., Canellos, G. P., Schwartz, L. H., Takvorian, R. W., Juweid, M. E., & Cheson, B. D. (2011). Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET. Blood, 117(20), 5314–5320. https://doi.org/10.1182/blood-2010-10-314260

Sureda, A., Domingo-Domenech, E., & Gautam, A. (2019). Neutropenia during frontline treatment of advanced Hodgkin lymphoma: Incidence, risk factors, and management. Critical Reviews in Oncology/Hematology, 138, 1–5. https://doi.org/10.1016/j.critrevonc.2019.03.016

• HTML
• PDF

• Tumor Biology and Mechanisms

Copyright (c) 2026 Elaf Ali Jamaluldeen, Aula Fadhil Alwan, Rasha Hassan Abdulhussein Al-Oraibi, Mohammed Kamil Al Qayyim, Musaab Kadhim Alabboodi

This work is licensed under a Creative Commons Attribution 4.0 International License.