{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:05:57Z","timestamp":1790654757082,"version":"4.1.0"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016036","name":"Health~Holland","doi-asserted-by":"publisher","award":["TKI2209"],"award-info":[{"award-number":["TKI2209"]}],"id":[{"id":"10.13039\/100016036","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Background\/Objectives: Hematological toxicities (i.e., neutropenia, thrombocytopenia, and anemia), are common chemotherapy complications and may be exacerbated by renal or hepatic impairment due to altered drug exposure. This study assessed the association between renal and hepatic impairment and hematologic toxicities during chemotherapy in routine clinical practice. Methods: A single-center retrospective cohort study using the Utrecht Patient Oriented Database (UPOD) identified all chemotherapy administrations at the University Medical Centre Utrecht between 2011 and 2024. Regimens administered in \u226510 patients and \u22655 renally (GFR &lt; 60 mL\/min) or hepatically (bilirubin or AST &gt; 1\u00d7 ULN) impaired patients were included in descriptive analyses. Cox proportional hazards models estimated associations between organ impairment and grade \u2265 3 hematologic toxicities for regimens with \u226510 events per toxicity endpoint. Results: Overall, 4489 patients were included in renal analyses and 6218 in hepatic analyses, with smaller endpoint-specific subgroups for survival analyses. Renal impairment was associated with grade \u2265 3 neutropenia (HR: 1.43 [95% CI: 1.18\u20131.73]), thrombocytopenia (HR: 1.46 [95% CI: 1.15\u20131.86], and anemia (HR: 1.66 [1.27\u20132.16]). Hepatic impairment was similarly associated with neutropenia (HR: 1.25 [95% CI: 1.11\u20131.40]), thrombocytopenia (HR: 1.33 [95% CI: 1.13\u20131.57]), and anemia (HR: 1.62 [95% CI: 1.34\u20131.95]). Cyclophosphamide (pro-drug) regimens showed higher toxicity risk in renally impaired patients and reduced risk in hepatically impaired patients. Etoposide, melphalan and methotrexate were associated with increased toxicity in hepatically impaired patients. Conclusions: Renal and hepatic impairment significantly increase chemotherapy-induced hematologic toxicity. Several high-risk chemotherapy regimens were identified; however, larger multi-center datasets are needed to refine dosing guidance based on renal and hepatic function.<\/jats:p>","DOI":"10.3390\/pharmaceutics17101280","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T16:43:54Z","timestamp":1759250634000},"page":"1280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Chemotherapy-Induced Hematological Toxicity in Patients with Renal or Hepatic Impairment"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9457-3306","authenticated-orcid":false,"given":"Kelly","family":"Nies","sequence":"first","affiliation":[{"name":"Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5734-4566","authenticated-orcid":false,"given":"Robin","family":"Vernooij","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"},{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"},{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lot","family":"Devriese","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Hendrik","family":"Venhuizen","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1252-0383","authenticated-orcid":false,"given":"Maarten","family":"ten Berg","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Swart","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9986-0542","authenticated-orcid":false,"given":"Laureen","family":"Lammers","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5465-4868","authenticated-orcid":false,"given":"Saskia","family":"Haitjema","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.3748\/wjg.v20.i6.1565","article-title":"Prognostic value of chemotherapy-induced hematological toxicity in metastatic colorectal cancer patients","volume":"20","author":"Rambach","year":"2014","journal-title":"World J. 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