A blood test, known as a complete blood count (CBC) measuresred blood cells (RBCs),white blood cells (WBCs), andplatelets. When cell counts are low or expected to become low, bone marrow stimulating drugs can be given to boost your body’s production of these blood cells.
These agents have potentially serious risks and side effects, and not all cases of “low counts” are treated with these drugs. In the treatment of cancer, the use of bone marrow boosting drugs is considered supportive care, meaning that the drug does not directly fight cancer, but helps in other ways.
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Your Bone Marrow, Up Close
Bone marrowis the living tissue that is packed inside the hollows of certain bones, especially the hipbones and the vertebrae, or the bones of the spinal column.
The bone marrow is where most of yourhematopoietic stem cellsare located. Hematopoietic stem cells divide and give rise to all of the different kinds of blood cells, including RBCs, WBCs, and platelets.
A Look at Hematopoiesis
Cancer and the Bone Marrow
Bone marrow may be unhealthy for a variety of reasons. In the case of certain blood cancers, the cancer cells grow in the bone marrow. And many chemotherapy drugs are toxic to the bone marrow.
Without healthy bone marrow, blood cell production suffers, and new blood cells can’t be made to keep pace with the natural recycling of blood cells. This can be an especially serious problem when blood cells rapidly die as a side effect of cancer treatment.
What Is Bone Marrow Stimulation?
Healthy bone marrow responds to the body’s chemical signals that trigger blood cell production. Scientists have learned to make treatments that replicate these chemical signals, and they can be used medically to boost production. They are often given in larger doses than the body normally produces.
Different “families” or progenitors of blood cell types in the marrow may respond to different chemical signals. One general term for a chemical signal that boosts production ishematopoietic growth factor.Not all drugs that boost the bone marrow are growth factors, however.
Why Is Bone Marrow Stimulation Done?
There are specific circumstances that necessitate the use of bone marrow stimulation.
Raising Low Counts
Stimulating the body toproduce more new blood cellscan be helpful when one or more of your blood cell counts are low or your counts are expected to become very low. For instance, sometimes the bone marrow is stimulated in advance, as a preventive measure, when counts are expected to fall due to planned cancer therapy.
If you receivecytotoxicchemotherapy, you can have extremely low counts for long periods of time. Levels of neutrophils, a type of WBC, are carefully tracked.
Low levels of neutrophils correlate with the risk of infection. A neutrophil count below a certain threshold is termedneutropenia, and a very low level is known as profound neutropenia.
Preparing to Donate Stem Cells
Healthy people may be given bone marrow stimulation treatments in preparation for donating stem cells to another person, for a peripheral blood stem cell transplant.
According to the National Marrow Donor Program, or “Be The Match,” a person donating stem cells receives injections of filgrastim, a growth factor, over a period of 5 days prior to donation.Filgrastim is used to increase the number of blood-forming cells in the bloodstream. Then, on the day of donation, the volunteer’s blood is drawn through a needle on one arm and passed through a machine that collects the stem cells. The remaining blood is returned to the volunteer through the other arm.
What Are the Risks of Donating Bone Marrow?
Types of Bone Marrow Stimulating Medications
Because of the expense and potential for serious side effects, expert committees issue and update guidelines to help healthcare providers determine when to use bone marrow stimulating treatments.
Growth Factors to Boost White Blood Cells
Growth factors or “colony-stimulating factors” that help boost WBCs include the following:
Both types of growth factors—G-CSFs and GM-CSFs—can improve WBC production.Most medical institutions use G-CSF, and this is the most established type and one that has been studied the most.
When Would You Get Growth Factors to Boost WBCs?
G-CSFs may be given during the first cycle of chemotherapy to help prevent neutropenia throughout all of the chemotherapy cycles.G-CSFs also help limit the incidence ofneutropenic fever, and they may reduce the need for hospitalization.
They can also be used to allow higher doses of chemotherapy, in scenarios where lowering the chemotherapy dose might lead to a worse prognosis.
G-CSFs are sometimes given during chemo re-treatment when a previous cycle of chemotherapy caused a neutropenic fever, and also to shorten the length of time a person has severe neutropenia from chemo when there is no fever. G-CSFs may also be given when a personalready hasa fever and neutropenia.
Growth Factors to Boost Red Blood Cells
Growth factors that help boost erythrocytes (RBCs), include the following:
Erythropoietin treatment can help some people avoid transfusions of RBCs.Getting treatment with erythropoietin and G-CSF improves the response to the erythropoietin.
How Can You Increase Your Red Blood Cells?
Boosting Platelets
How to Increase Platelet Count Naturally
When to See Your Healthcare Provider
If you are taking a bone marrow stimulating medication, notify your healthcare provider if you begin to develop any concerning symptoms.
Contact your healthcare provider immediately if you experience any of the following:
A Word From Verywell
Researchers are examining the best ways to tell which patients might benefit from growth factors that boost blood cell and platelet production. There is also a lot of interest in determining the best way to combine growth factors with each other and withchemotherapyand hormone therapy.
If you have been told you have low counts and are wondering why you are not receiving blood-boosting medication, bring these questions up with your healthcare team. Often, there are very specific criteria for such therapy, and decisions are made in view of your particular illness, medical history, and treatment plans. Not everybody is a good candidate, but in the right scenario, these medications can help prevent serious neutropenia, fevers, and infections.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Marrow Donor Program, Be the Match.Donating peripheral blood stem cells. 2019.Smith TJ, Bohlke K, Lyman GH, et al.Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update.J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488Metcalf D.The colony-stimulating factors and cancer.Nat Rev Cancer. 2010;10(6):425-434. doi:10.1038/nrc2843Lyman GH, Allcott K, Garcia J, et al.The effectiveness and safety of same-day versus next-day administration of long-acting granulocyte colony-stimulating factors for the prophylaxis of chemotherapy-induced neutropenia: a systematic review.Support Care Cancer. 2017;25(8):2619-2629. doi:10.1007/s00520-017-3703-yKei T, Mistry N, Curley G, et al.Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis.Can J Anaesth. 2019;66(6):716-731. doi:10.1007/s12630-019-01351-6Kuter DJ, Rummel M, Boccia R, et al.Romiplostim or standard of care in patients with immune thrombocytopenia.N Engl J Med.2010;363(20):1889-1899. doi:10.1056/NEJMoa1002625Additional ReadingBe The Match National Marrow Donor Program.Steps of PBSC or Bone Marrow Donation.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Marrow Donor Program, Be the Match.Donating peripheral blood stem cells. 2019.Smith TJ, Bohlke K, Lyman GH, et al.Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update.J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488Metcalf D.The colony-stimulating factors and cancer.Nat Rev Cancer. 2010;10(6):425-434. doi:10.1038/nrc2843Lyman GH, Allcott K, Garcia J, et al.The effectiveness and safety of same-day versus next-day administration of long-acting granulocyte colony-stimulating factors for the prophylaxis of chemotherapy-induced neutropenia: a systematic review.Support Care Cancer. 2017;25(8):2619-2629. doi:10.1007/s00520-017-3703-yKei T, Mistry N, Curley G, et al.Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis.Can J Anaesth. 2019;66(6):716-731. doi:10.1007/s12630-019-01351-6Kuter DJ, Rummel M, Boccia R, et al.Romiplostim or standard of care in patients with immune thrombocytopenia.N Engl J Med.2010;363(20):1889-1899. doi:10.1056/NEJMoa1002625Additional ReadingBe The Match National Marrow Donor Program.Steps of PBSC or Bone Marrow Donation.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Marrow Donor Program, Be the Match.Donating peripheral blood stem cells. 2019.Smith TJ, Bohlke K, Lyman GH, et al.Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update.J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488Metcalf D.The colony-stimulating factors and cancer.Nat Rev Cancer. 2010;10(6):425-434. doi:10.1038/nrc2843Lyman GH, Allcott K, Garcia J, et al.The effectiveness and safety of same-day versus next-day administration of long-acting granulocyte colony-stimulating factors for the prophylaxis of chemotherapy-induced neutropenia: a systematic review.Support Care Cancer. 2017;25(8):2619-2629. doi:10.1007/s00520-017-3703-yKei T, Mistry N, Curley G, et al.Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis.Can J Anaesth. 2019;66(6):716-731. doi:10.1007/s12630-019-01351-6Kuter DJ, Rummel M, Boccia R, et al.Romiplostim or standard of care in patients with immune thrombocytopenia.N Engl J Med.2010;363(20):1889-1899. doi:10.1056/NEJMoa1002625
National Marrow Donor Program, Be the Match.Donating peripheral blood stem cells. 2019.
Smith TJ, Bohlke K, Lyman GH, et al.Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update.J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488
Metcalf D.The colony-stimulating factors and cancer.Nat Rev Cancer. 2010;10(6):425-434. doi:10.1038/nrc2843
Lyman GH, Allcott K, Garcia J, et al.The effectiveness and safety of same-day versus next-day administration of long-acting granulocyte colony-stimulating factors for the prophylaxis of chemotherapy-induced neutropenia: a systematic review.Support Care Cancer. 2017;25(8):2619-2629. doi:10.1007/s00520-017-3703-y
Kei T, Mistry N, Curley G, et al.Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis.Can J Anaesth. 2019;66(6):716-731. doi:10.1007/s12630-019-01351-6
Kuter DJ, Rummel M, Boccia R, et al.Romiplostim or standard of care in patients with immune thrombocytopenia.N Engl J Med.2010;363(20):1889-1899. doi:10.1056/NEJMoa1002625
Be The Match National Marrow Donor Program.Steps of PBSC or Bone Marrow Donation.
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