The use of lithium carbonate to reduce infection and leukopenia during systemic chemotherapy

N Engl J Med. 1980 Jan 31;302(5):257-60. doi: 10.1056/NEJM198001313020503.

Abstract

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 less than 0.05). Delay in subsequent chemotherapy was longer (P less than 0.01) and the number of dose reductions greater (P less than 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 less than 0.05) and correlated with concurrent serum lithium levels (rs = 0.74, P less than 0.05). We believe that lithium carbonate shows promise as a means of lowering the risk of infection among patients receiving cytotoxic therapy.

Publication types

  • Clinical Trial

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Carcinoma, Bronchogenic / complications
  • Carcinoma, Bronchogenic / drug therapy*
  • Carcinoma, Bronchogenic / radiotherapy
  • Carcinoma, Small Cell / complications
  • Carcinoma, Small Cell / drug therapy*
  • Carcinoma, Small Cell / radiotherapy
  • Clinical Trials as Topic
  • Cyclophosphamide / adverse effects
  • Doxorubicin / adverse effects
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infection Control*
  • Infections / etiology
  • Leukocyte Count
  • Leukopenia / chemically induced
  • Leukopenia / prevention & control*
  • Lithium / therapeutic use*
  • Lithium / toxicity
  • Lung Neoplasms / complications
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / radiotherapy
  • Male
  • Middle Aged
  • Random Allocation
  • Vincristine / adverse effects

Substances

  • Antineoplastic Agents
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Lithium