Exercise training as prophylactic strategy in the management of neutropenia during chemotherapy

Abstract

Chemotherapy‐induced immune‐suppression is a common, but potential detrimental, adverse reaction in patients undergoing treatment for cancer and strategies with capacity to boost the immune cell populations are needed. Physical exercise training is a potent regulator of immune cell viability and function and may serve as a viable, non‐pharmacological prophylactic strategy in addition to the current pharmacological management by, for example, granulocyte‐colony stimulating factor (G‐CSF). Here, we review the mechanistic evidence linking exercise training to haematopoietic function and subsequent possible amelioration of chemotherapy‐related neutropenia. First, we briefly describe neutrophil regulation and management of neutropenia in cancer patients. Second, we summarize the effect of acute and chronic exercise training on neutrophils and their progenitors, and finally, we outline the current clinical evidence of exercise interventions in ongoing anti‐cancer treatment in regard to neutropenia incidence, treatment tolerance and related outcomes. LINKED ARTICLES This article is part of a themed issue on New avenues in cancer prevention and treatment (BJP 75th Anniversary). To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.12/issuetoc

Presence of viremia during febrile neutropenic episodes in patients undergoing chemotherapy for malignant neoplasms

“…This observation could be attributable to the lower severity of immunosuppression in the chemotherapy setting, although the degree of immunosuppression conveyed by chemotherapeutics can be considerable. 2,5,14,47 In contrast to earlier analyses in HSCT recipients performed at our center, 10,20,22,48 no cases of adenoviremia have been detected in the transplant recipients in the present study (Figure S1B, Additional file 1). In the cohort of patients undergoing chemotherapy, one case of adenoviremia was detected (Figure 2(B)), and screening of F I G U R E 4 Association of viremia at onset of fever and persistent fever with virus copy numbers.…”

“…In contrast to patients undergoing HSCT, where concomitant reactivation of multiple viruses reflects the state of severe immunosuppression, 6,19 viral co‐infection in the febrile neutropenic patients on chemotherapy was found in a single case only. This observation could be attributable to the lower severity of immunosuppression in the chemotherapy setting, although the degree of immunosuppression conveyed by chemotherapeutics can be considerable 2,5,14,47 . In contrast to earlier analyses in HSCT recipients performed at our center, 10,20,22,48 no cases of adenoviremia have been detected in the transplant recipients in the present study (Figure S1B, Additional file 1).…”

Effects of Exercise Interventions on Immune Function in Children and Adolescents With Cancer and HSCT Recipients - A Systematic Review

“…Thus, abnormal low frequencies of neutrophils, called neutropenia, can increase the chance of life-threatening infections and is a common side effect during cancer therapy ( 37 – 39 ). This finding by Ladha et al ( 34 ) is in line with published data from adult cancer patients, where an increase in neutrophil function was observed after acute exercise ( 40 ). Studies in adult cancer patients and experimental mouse models further suggest that regular exercise intervention sustains enhanced neutrophil function and migratory capacity ( 40 , 41 ).…”

“…This finding by Ladha et al ( 34 ) is in line with published data from adult cancer patients, where an increase in neutrophil function was observed after acute exercise ( 40 ). Studies in adult cancer patients and experimental mouse models further suggest that regular exercise intervention sustains enhanced neutrophil function and migratory capacity ( 40 , 41 ). Furthermore, exercise can reduce chemotherapy related neutropenia in cancer patients ( 40 ) which might decrease the risk of infections in cancer patients.…”

“…Studies in adult cancer patients and experimental mouse models further suggest that regular exercise intervention sustains enhanced neutrophil function and migratory capacity ( 40 , 41 ). Furthermore, exercise can reduce chemotherapy related neutropenia in cancer patients ( 40 ) which might decrease the risk of infections in cancer patients. This is in line to a lower number of total and viral infections that could be observed ( 15 ).…”