Risk Factors of Hematological Toxicity of Mesothelioma Treatment-A Territory-Wide Retrospective Study

Our plain-English summary of Risk Factors of Hematological Toxicity of Mesothelioma Treatment-A Territory-Wide Retrospective Study, by W.C. Kwok, D.Y.H. Yap, I.S.H. Leung, et al (Thoracic Cancer, 2026).

The study

• Authors: W.C. Kwok, D.Y.H. Yap, I.S.H. Leung, J.C.M. Ho
• Journal: Thoracic Cancer
• Published: 2026;17(2):e70243
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: While chemotherapy remains the treatment of choice for mesothelioma, it carries significant toxicities, especially hematological toxicity.

Methods: We conducted this territory-wide retrospective study in Hong Kong to investigate the prevalence and risk factors of hematological toxicity associated with mesothelioma treatment.

Results: A total of 222 patients were included in the analysis. Lower baseline serum albumin level and more lines of cytotoxic chemotherapy received were risk factors for developing grade 3-4 hematological toxicity with aOR of 1.05 (95% CI, 1.02-1.09, p = 0.003) and 1.50 (95% CI, 1.03-2.19, p = 0.033) respectively. Risk factors for developing neutropenic fever included: diabetes mellitus (aOR = 9.44, 95% CI, 2.59-34.45, p < 0.001); the use of chemotherapy other than pemetrexed (aOR = 4.80, 95% CI, 1.05-21.89, p = 0.043); the presence of third-space fluid (aOR = 3.58, 95% CI, 1.16-11.05, p = 0.027), pleural effusion (aOR = 4.20, 95% CI, 1.34-13.17, p = 0.014) and pericardial effusion (aOR = 7.97, 95% CI, 1.18-53.93, p = 0.033). Number of lines of cytotoxic chemotherapy the patients received was the risk factor for pack cell transfusion with aOR of 2.35 (95% CI, 1.54-3.60, p < 0.001).

Conclusion: Hematological toxicities were commonly seen in the treatment course of mesothelioma. Risk factors include disease factors and treatment factors. Use of ICI could bring about hope in reducing the risk of hematological toxicities.

© 2026 The Author(s). Thoracic Cancer published by John Wiley & Sons Australia, Ltd.

In plain English

This retrospective study used Hong Kong public hospital records on 222 adults with mesothelioma (2000 to 2022) to examine blood-related (hematological) side effects of treatment. In the article's table, 132 had grade 3 to 4 hematological toxicity. In adjusted analyses, grade 3 to 4 toxicity was associated with lower baseline albumin (adjusted odds ratio 1.05, 95% CI 1.02 to 1.09) and more chemotherapy lines (1.50, 1.03 to 2.19). Adjusted odds ratios for neutropenic fever were 9.44 (2.59 to 34.45) for diabetes, 4.20 (1.34 to 13.17) for pleural effusion, 7.97 (1.18 to 53.93) for pericardial effusion, 4.80 (1.05 to 21.89) for non-pemetrexed chemotherapy and 3.58 for third-space fluid, whose interval differs between abstract and table. More chemotherapy lines were associated with packed cell transfusion (2.35, 1.54 to 3.60). The authors concluded that hematological toxicities were common and that immune checkpoint inhibitors could bring hope of reducing them, though only an unadjusted table compares their use between toxicity groups (p = 0.77). Stated limitations included mostly Chinese patients, 251 exclusions, limited power, missing smoking history, changing regimens and limited pemetrexed availability.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Territory-wide retrospective study of electronic health records (Clinical Data Analysis and Reporting System, Hong Kong Hospital Authority), with multiple logistic regression adjusted for age, sex, baseline eGFR, Charlson Comorbidity Index and lines of chemotherapy
• Who was studied: 222 patients aged 18 or over with mesothelioma followed up in the Hospital Authority of Hong Kong from 1 January 2000 to 31 December 2022; mean age 54.2 plus or minus 14.8 years; 152 (68.5%) male; mostly Chinese. The site of mesothelioma (pleural, peritoneal) is not broken down.
• Exposure: Mesothelioma treatment over more than 20 years with changing regimens, including pemetrexed, gemcitabine, carboplatin, cisplatin, mitomycin C with vinblastine and cisplatin or carboplatin (MVP), doxorubicin, etoposide, bevacizumab and immune checkpoint inhibitors. Asbestos exposure was not studied.
• Main results:
  • 132 of the 222 patients had grade 3 to 4 hematological toxicities (Table 1)
  • Grade 3 to 4 hematological toxicity, whole cohort: lower baseline albumin level had an adjusted odds ratio of 1.05 (95% CI 1.02 to 1.09), with p = 0.043 in Table 2. The abstract gives p = 0.003, and the unit of albumin is not stated.
  • Grade 3 to 4 hematological toxicity, whole cohort: each additional line of cytotoxic chemotherapy had an adjusted odds ratio of 1.50 (95% CI 1.03 to 2.19, p = 0.033)
  • Neutropenic fever, whole cohort: diabetes mellitus had an adjusted odds ratio of 9.44 (95% CI 2.59 to 34.45, p less than 0.001)
  • Neutropenic fever, whole cohort: chemotherapy other than pemetrexed had an adjusted odds ratio of 4.80 (95% CI 1.05 to 21.89, p = 0.043)
  • Neutropenic fever, whole cohort: third-space fluid had an adjusted odds ratio of 3.58, with 95% CI 1.07 to 5.48 and p = 0.034 in Table 2. The abstract gives 95% CI 1.16 to 11.05 and p = 0.027.
  • Neutropenic fever, whole cohort: pleural effusion had an adjusted odds ratio of 4.20 (95% CI 1.34 to 13.17, p = 0.014)
  • Neutropenic fever, whole cohort: pericardial effusion had an adjusted odds ratio of 7.97 (95% CI 1.18 to 53.93, p = 0.033)
  • Packed cell transfusion for anemia, whole cohort: number of lines of chemotherapy had an adjusted odds ratio of 2.35 (95% CI 1.54 to 3.60, p less than 0.001)
  • Immune checkpoint inhibitors, Table 1 unadjusted comparison: 11 patients (5.0%) received them, 7 (5.3%) in the grade 3 to 4 toxicity group and 4 (4.4%) in the group without such toxicity, p = 0.77
  • Subgroup of 62 patients with at least one of hypertension, diabetes mellitus, ischemic heart disease, heart failure or stroke: diabetes mellitus was associated with grade 3 to 4 hematological toxicity (adjusted odds ratio 7.12, 95% CI 1.71 to 29.60, p = 0.007)
  • Same subgroup of 62 patients: diabetes mellitus was associated with neutropenic fever (adjusted odds ratio 14.92, 95% CI 1.17 to 190.18, p = 0.037)
  • Same subgroup of 62 patients: number of lines of cytotoxic chemotherapy was associated with packed cell transfusion for anemia (adjusted odds ratio 2.30, 95% CI 1.43 to 3.68, p less than 0.001)
• The authors' conclusion: The authors concluded that hematological toxicities were commonly seen during mesothelioma treatment. They identified risk factors in three groups: patient factors (low baseline serum albumin, diabetes mellitus), disease factors (pleural or pericardial effusion) and treatment factors (chemotherapy other than pemetrexed, more lines of cytotoxic chemotherapy). They added that use of immune checkpoint inhibitors could bring hope in reducing these risks.
• Limitations the authors state:
  • Most patients were Chinese, which may affect generalizability
  • 251 patients meeting exclusion criteria were excluded, leaving a relatively small sample
  • Some risk factors may not have been detected because of lack of statistical power
  • The database lacked granular data, so characteristics such as smoking and drinking history could not be properly assessed
  • The study covered more than 20 years with different treatment regimens in use
  • Fewer than half of patients received pemetrexed because of its limited availability and funding in the Hospital Authority formulary over the study period

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Chemotherapy, Pemetrexed (Alimta), Pleural Effusion, Pericardial Effusion.

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