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The Use of Lithium Carbonate to Reduce Infection and Leukopenia during Systemic Chemotherapy

1980; Massachusetts Medical Society; Volume: 302; Issue: 5 Linguagem: Inglês

10.1056/nejm198001313020503

1533-4406

Gary H. Lyman, Charles C. Williams, Dennis Preston,

Acute Lymphoblastic Leukemia research

To investigate whether lithium ameliorates the infectious complications that accompany systemic chemotherapy, we studied 45 patients with small-cell bronchogenic carcinoma receiving combination chemotherapy and radiation therapy. Twenty received lithium carbonate, and 25 received no additional therapy. Control subjects experienced more days with neutropenia than the lithium-treated group (2.17 days per 100 patient-days vs. 0.29), more severe febrile episodes (seven patients vs. one patient), more days hospitalized with fever and neutropenia (1.92 per 100 patient-days vs. 0.18), and more infection-related deaths (five vs. none). Infection-free survival was significantly longer in the lithium-treated group than in controls (P<0.05). Delay in subsequent chemotherapy was longer (P<0.01) and the number of dose reductions greater (P<0.01) in the control group. For both leukocytes and neutrophils, the first cycle nadir, mean of all treatment nadirs, and the lowest nadir observed during treatment were significantly higher in the lithium group. Mean mid-cycle monocyte counts were greater in the lithium group (P<0.05) and correlated with concurrent serum lithium levels (rs = 0.74, P<0.05). We believe that lithium carbonate shows promise as a means of lowering the risk of infection among patients receiving cytotoxic therapy. (N Engl J Med 302:257–260, 1980)