Incidence of Anaemia and Thrombocytopenia Following Breast Cancer Chemotherapeutic Regimens AC-T, AC-T+C and AC-T+Tr in a Tertiary Care Center
Authors: S Arun , Mohamedali Seema P. , T Ajaykumar , M Anuradha 
Published: August 2024

BACKGROUND: In breast cancer the most commonest regimen used for the neoadjuvant and adjuvant nonmetastatic setting is the 4 cycles of Adriamycin and cyclophosphamide followed by Docetaxel, docetaxel + trastuzumab and docetaxel and carboplatin regimens. (1)
In patients with breast cancer treated with three different chemotherapeutic regimens like AC-T (Adriamycin and cyclophosphamide followed by docetaxel) Regimen I, AC-T+C (Adriamycin and cyclophosphamide followed by docetaxel and Carboplatin) regimen II, AC-T+Tr (Adriamycin and cyclophosphamide followed by docetaxel and trastuzumab) regiment iii in a tertiary care hospital. out of which myelosuppression was the major concern in treatment follow-ups. I was here reviewing the incidence and management of anemia during the post-chemotherapy period.
METHODS: A prospective open-labelled observational comparative study to evaluate the incidence of anemia and thrombocytopenia among the three regimens of chemotherapy regimen AC-T, Regime II AC-T+C, Regimen III AC-T+Tr. All enrolled patients received pegfilgrastim/filgrastim either prophylactically or as a part of the case of myelosuppression occurred. regimen I enrolled and completed a study of 38 patients, regimen II 40 patients, and regimen III 46 patients. All those patients underwent statistical analysis using SPSS.
RESULTS: 882(88.9%) episodes of anemia (all grades) out of a total of 992 cycles of chemotherapy observed. 27 patients of Regimen I and II, and 31 patients of Regimen III had at least one episode of anemia (grade 2 or above) in their cycles of chemotherapy. Out of which overall 293 episodes of grade 2, 21 episodes of grade 3, and 3 episodes of grade 4 anemia among all 3 study regimens. The mean incidence of anemia in regimen I in the initial 4 cycles: was 3.4+ 1.1, in the final 4 cycles: 3.7+ 0.6, and in the overall 8 cycles: 7.1+1.5. In regimen II as in the initial 4 cycles:3.5+ 0.8, in the final 4 cycles:3.9+0.4, in overall 8 cycles:7.4+1.1. In regimen III as in the initial 4 cycles:3.3+1, in the final 4 cycles: 3.7+ 0.6, and in the overall 8 cycles:7.1+1.5. The mean incidence of all grades of anemia is comparable among 3 study regimens with a mean incidence of 7.1 in regimen I, 7.4 in regimen II, 7.1 in regimen III in overall 8 cycles of chemotherapy. There is no statistically significant difference in the mean incidence of anemia among 3 study groups
109 episodes of thrombocytopenia out of 992 cycles of chemotherapy (10.9%) were observed. In the initial 4 cycles of chemotherapy, 44 episodes, and in the final 4 cycles as 65 episodes occurred. Grade 2 and above thrombocytopenia of at least one episode in the treatment period was reported in 6 patients in regimen I, 5 patients in regimen II, and 1 patient in regimen III. Of total thrombocytopenia of grade 2 and above only 6 episodes in regimen I, 5 episodes in regimen II, and 2 episodes in regimen III were noted. Mean incidence of thrombocytopenia in regimen I in the initial 4 cycles: 0.1+ 0.5, in final 4 cycles: 0.2+ 0.6, in overall 8 cycles: 0.3+ 1. In regimen II as in the initial 4 cycles:0.1+ 0.3, in the final 4 cycles:0.3+0.6, in overall 8 cycles:0.4+0.7. In regimen III as in the initial 4 cycles:0+0, in the final 4 cycles: 0.1+ 0.4, and in the overall 8 cycles:0.1+0.4. The mean incidence of thrombocytopenia of all grades is comparable among 3 study regimens with 0.3 in regimen I,0.4 in regimen II, 0.1 in regimen III in overall 8 cycles of chemotherapy. There is no statistically significant difference in the mean incidence of thrombocytopenia among the 3 study regimens.
CONCLUSION: On comparing the mean incidence of anemia there is no statistically significant difference among the 3 regimens of study in the initial 4 chemo cycles, final 4 chemo cycles, and overall 8 cycles of chemotherapy. There is a statistically significant difference in the mean incidence of thrombocytopenia in the initial 4 cycles of chemotherapy among 3 regimens. However, in the overall 8 cycles of chemotherapy, there is no statistically significant difference in mean incidence of thrombocytopenia among the three regimens. The trend of decline in mean hemoglobin value is noticed towards the later cycles of chemotherapy in the overall study population due to the cumulative toxicity of chemo regimens in bone marrow.