Hematological changes and predictors of bone marrow recovery in patients with neutropenic episodes in acute lymphoblastic leukemia

A total of 30 episodes of neutropenia in 16 patients of acute lymphoblastic leukemia, aged between 1 and 12 years were studied prospectively. In the initial treatment phase (induction of remission, consolidation and CNS prophylaxis) 92.8 per cent episodes were prolonged (> 7 days) and 85.7 per cent of them had profound neutropenia (absolute neutrophil counts < 0.200 x 10(9)/l). In contrast, in the maintenance phase, only 64.2 per cent were of prolonged duration; of them 57.1 per cent had profound neutropenia. Most patients in neutropenia of prolonged duration had anemia (Hb < 8 g/100 ml) and thrombocytopenia (platelet < 100 x 10(9)/l). Regularly increasing trends were seen in total leucocyte counts (TLC), absolute monocyte counts (AMC) and platelet counts from 4 days prior to recovery of absolute neutrophil counts (ANC). Of all the parameters, platelet count (> 100 x 10(9)/l) and AMC (> 0.1 x 10(9)/l) recovered 4 and 1 days, respectively, prior to recovery of ANC above 0.5 x 10(9)/l. Recovery of platelet counts (4 days prior to recovery of ANC) and possibly AMC can be considered early predictors of bone marrow recovery. These parameters can be used in conjunction with clinical condition to decide about early discharge of leukemia patients with neutropenia, especially in developing countries where prolonged stay can result in hospital acquired infections.