Effects of lithium on thrombopoiesis in patients with low platelet cell counts following chemotherapy or radiotherapy

Therapy for neoplasma is limited by hematological side effects of tumor-des tructive therapy and, in part, makes expensive supportive care necessary to overcome and treat leukopenia and thrombocytopenia and their consequences. Thrombocytopenia is a major clinical problem caused by chemotherapy and ra diotherapy. An effective and very cost-effective option for treating modera te neutropenia is the administration of lithium carbonate. Lithium induces the release of colony-stimulating factors (CSF) and therefore stimulates pr oliferation of neutrophil granulocytes. Other cytokines, such as interleuki n-1 (IL-1), IL-6, and tumor-necrosis factor-alpha (TNF-alpha), are also sti mulated. Apart from granulocyte-macrophage-CSF (GM-CSF), there have as yet been no reports of lithium salts inducing early activating factors for the megakaryocytic lineage, such as IL-3, IL-11, stem cell factor and flt-3 lig and, or maturation factors, such as thrombopoietin (TPO). A statistically s ignificant increase in the mean number of platelets for patients with cell counts below 150,000/ muL on the commencement of treatment with lithium car bonate could be observed. Patient tolerability of lithium carbonate therapy is very good. Patients with persistent leukopenia and thrombocytopenia fol lowing chemotherapy or radiotherapy can be treated with this trace element very cost-effectively. Unfortunately this treatment has not gained acceptan ce in clinical oncology in the face of extremely cost-intensive treatment w ith recombinant GM-CSF, IL-11 or, potentially, thrombopoietin.