Myelosuppression (Bone Marrow Suppression)

What is myelosuppression?

Myelosuppression (bone marrow suppression) happens when something affects your bone marrow so it doesn’t work as it should.

Bone marrow is the soft spongy tissue inside your bones. Every day, it produces and releases billions of red blood cells, white blood cells and platelets that you need to survive. Your blood cells and platelets support your overall health in different ways. Your bone marrow adjusts its production based on your body’s changing needs.

In myelosuppression, something interferes with that production process. Chemotherapy to treat cancer is the most common reason, but some blood cancers and viruses may also affect your bone marrow’s ability to make the right number of blood cells and platelets.

What are symptoms of myelosuppression?

Myelosuppression symptoms may vary depending on how it affects your blood cells and platelets. Your red blood cells, white blood cells and platelets support your body in different ways. When your bone marrow doesn’t make enough red blood cells or platelets, you may develop certain blood disorders such as anemia or thrombocytopenia. If your white blood cell levels are low, you may have an increased risk of infection.

Anemia

Anemia happens when you don’t have enough red blood cells. Your red blood cells carry oxygen throughout your body. Anemia symptoms include:

• Fatigue.
• Shortness of breath (dyspnea).
• Dizziness.
• Fast or irregular heartbeat (arrhythmia).
• Pounding or “whooshing” sound in your ear (pulsatile tinnitus).
• Headache.
• Skin color that’s more pale than usual.
• Chest pain.

Neutropenia

Myelosuppression may keep your bone marrow from making enough neutrophils, a white blood cell that destroys germs that cause infections. People with lower-than-normal neutrophil levels have neutropenia. Neutropenia doesn’t cause symptoms, but the infections that may result from having neutropenia can. Repeated infections may also be a sign of neutropenia. Symptoms of infection may include:

• Fever (febrile neutropenia).
• Fatigue.
• Sore throat (pharyngitis).
• Swollen lymph nodes.
• Ulcers in your mouth or around your anus.
• Diarrhea.
• A burning sensation when you pee, feeling as if you need to pee right away or need to pee more often than usual.

Thrombocytopenia

Platelets help control bleeding. People with low platelet levels have thrombocytopenia. Thrombocytopenia symptoms include:

• A cut or a nosebleed that won’t stop bleeding.
• Bruises that happen more frequently than usual.
• Petechiae, which may look like a rash on your lower legs.
• Purpura, which may look like red, purple or brown spots on your skin.

Pancytopenia

When blood cell and platelet levels are all low, you have pancytopenia. Like neutropenia, pancytopenia isn’t a disease but it may be a sign of underlying conditions.

What causes myelosuppression?

Chemotherapy to treat cancer is the most common cause. But some blood cancers and certain viruses can affect your bone marrow and cause myelosuppression.

Chemotherapy, immunotherapy and myelosuppression

Several chemotherapies may cause myelosuppression, but the most common include:

• Fluorouracil.
• Oxaliplatin.
• Irinotecan.
• Capecitabine.

CAR T-cell therapy, which is a type of immunotherapy, may affect your bone marrow so it produces fewer blood cells and platelets.

Blood cancers and myelosuppression

Blood cancers can interrupt normal blood cell production. In blood cancers such as leukemia, lymphoma and myeloma, abnormal blood cells multiply in your bone marrow and keep it from producing healthy blood cells and platelets.

Viruses and myelosuppression

Viruses may cause myelosuppression by disrupting the blood cell production process. Your body fights intruders, including viruses, by rallying white blood cells that destroy intruders. When that happens, your bone marrow may make fewer red blood cells and platelets. Some research suggests certain viruses may infect blood-forming cells in your bone marrow and lower blood cell levels. Experts have linked the following viruses to myelosuppression:

• Epstein-Barr virus (EBV).
• Hepatitis C virus.
• Parvovirus 19.
• Cytomegalovirus (CMV).
• Chickenpox (varicella zoster).
• Human immunodeficiency virus (HIV).
• Dengue fever.

What are the complications of myelosuppression?

Myelosuppression may cause life-threatening complications such as acute anemia or uncontrollable bleeding.

How is myelosuppression diagnosed?

Healthcare providers diagnose this condition with blood tests to determine if your bone marrow is producing normal numbers of blood cells and platelets.

Blood tests may include:

• Complete blood count (CBC).
• Mean corpuscular volume (MCV) test.
• Red cell distribution width (RDW) test.
• Reticulocyte count.
• Peripheral blood smear.
• Mean platelet volume (MPV) test.

How is myelosuppression treated?

Healthcare providers treat myelosuppression by:

• Reducing or temporarily stopping chemotherapy that caused myelosuppression.
• Providing blood transfusions to increase red blood cell and platelet levels.
• Providing treatment that helps your bone marrow to produce more blood cells and platelets.

Can myelosuppression be prevented?

Myelosuppression usually happens during cancer treatment. Healthcare providers take steps to reduce the risk of myelosuppression by carefully monitoring treatment side effects, including myelosuppression.

What can I expect if I have myelosuppression?

Most people develop myelosuppression because they’re receiving chemotherapy. If that’s your situation, your healthcare provider will carefully monitor how chemotherapy affects your bone marrow. You may have to take a brief break from cancer treatment while your bone marrow builds up blood cell levels.

How do I take care of myself?

Myelosuppression may increase your risk of infection and bleeding. You may be able to reduce that risk by:

• Being vaccinated against common viruses.
• Practicing good health habits such as washing your hands and avoiding people who are sick.
• Protecting yourself from situations where you could be injured or cut.

What questions should I ask my healthcare provider?

You may want to ask your provider the following questions:

• Why do I have myelosuppression?
• How does this condition affect my body?
• What are my treatment options?
• Will treatment cure my myelosuppression?

A note from Cleveland Clinic

Your bone marrow — the soft spongy tissue inside your bones —is an essential part of your body. It produces red blood cells that carry oxygen, white blood cells that prevent infection and platelets that control bleeding. In myelosuppression, something prevents your bone marrow from doing its job. The most common cause is chemotherapy to treat cancer, but you may also develop myelosuppression if you have certain blood cancers or viruses. Healthcare providers treat myelosuppression by determining what’s keeping your bone marrow from its work and then managing the cause.