Myelotoxicity from cytostatic treatment, an important risk factor in the management of neoplasias in the elderly

Myelotoxicity is the most common complication of cancer chemotherapy. A brief review of hematopoiesis is necessary to understand the mechanisms of myelotoxicity and the treatment strategies that may minimize this complication in elderly patients. From this review of hematopoiesis and age, we may draw three conclusions: aging is associated with a progressive reduction in hematopoietic reserve; by itself, the decline in hematopoietic reserve does not produce abnormalities of the circulating blood, these may occur as a consequence of hematopoietic stress; hematopoietic growth factors are effective in promoting granulopoiesis and erythropoiesis in older individuals. Alternative strategies include reduction of chemotherapy doses, the use of prophylactic oral antibiotics and antifungal agents for the prevention of neutropenic infections, and blood transfusions for the management of anemia.