RDW AS A PREDICTOR OF BONE MARROW RECOVERY AFTER CHEMOTHERAPY IN HEMATOLOGICAL MALIGNANCIES

Background: Hematological malignancies can affect profound chemotherapy-induced bone marrow suppression, which can assign patients at risk for life-threatening neutropenia and thrombocytopenia. Conventional recovery markers like absolute neutrophil sums only measure marrow activity once mature cells develop circulating. Red cell distribution width is a readily available complete blood count parameter that may be used as an early surrogate marker of hematopoietic rebound.

Aim: The aim is to see if there are differences in bone marrow regeneration and lineage recovery timing after intensive chemotherapy in patients with hematological malignancies predicted by the presence of objective serial trends of the red cell distribution width.

Design: A retrospective observational analytical study of electronic medical records of tertiary care centers in Islamabad-Rawalpindi region for three years from 2022-2024. The study involved a group of 142 adult patients with acute leukemias, lymphomas or multiple myeloma undergoing chemotherapy. Baseline characteristics, chemotherapy intensity, transfusion volume and daily complete blood count parameters were retrieved. Analytical evaluations involved chi-square testing and multivariable binary logistic regression to determine independent association of an early increase in red cell distribution width (RCDW) (more than one point five percent increase from nadir) with rapid neutrophil recovery (within fourteen days).

Results: The median age of the group was forty-four point eight years and the condition was 40.8% AML. Forty-seven point two per cent of patients had a dynamic early increase in RDW, with the majority of these (sixty-five point seven per cent) showing rapid neutrophil recovery, whereas the rest of the patients (twenty point zero per cent) had a flat response (p-value less than zero point zero zero one). In multivariable logistic regression, an early rise in RDW was an independent positive predictor for rapid neutrophil recovery (adjusted odds ratio, 3.42, 95% CI, 1.68-6.95, p-value 0.001).

Conclusions: Highly significant early DAW increase was associated with faster recovery of neutrophils and platelets after chemotherapy. These findings indicate that longitudinal measurement of RVC can be a valuable, non-invasive parameter of BM activity to improve supportive care in hematological oncology.