Spectrum and influencing factors of hematological adverse events associated with postoperative adjuvant concurrent chemoradiotherapy for cervical cancer

To investigate the spectrum, independent risk factors, and clinical impact of hematological adverse events (HAEs) during postoperative adjuvant concurrent chemoradiotherapy (CRT) for cervical cancer (CC). This retrospective study included 284 patients with cervical cancer who underwent radical surgery followed by adjuvant CRT. HAEs were graded according to the Common Terminology Criteria for Adverse Events version 5.0. Patients were classified into a mild HAE group (grades 0–2; n = 163) and a severe HAE group (grades 3–4; n = 121) according to the maximum HAE grade observed during CRT. The incidence, onset, duration, treatment-related consequences, short-term response, and potential risk factors for HAEs were evaluated. Independent factors associated with severe HAEs were identified using multivariable logistic regression. Lymphopenia was the most frequent HAE (100.0%), with 37.67% of patients developing grade 3–4 lymphopenia. Leukopenia, neutropenia, anemia, and thrombocytopenia occurred in 93.66%, 74.65%, 60.92%, and 21.83% of patients, respectively. Lymphopenia occurred earliest, with a median onset time of 16.5 days, and reached grade 3–4 toxicity at a median of 25 days. Independent factors associated with severe HAEs were FIGO stage IIB–IIIC (OR = 2.148, 95% CI 1.271–3.628), pelvic bone marrow V40 ≥ 41% (OR = 7.389, 95% CI 3.712–14.710), and a history of neoadjuvant chemotherapy (OR = 2.438, 95% CI 1.156–5.141). Compared with the mild group, the severe group had longer HAE durations and higher rates of chemotherapy delay, dose reduction, and radiotherapy interruption. The 3-month complete response rate was lower in the severe group than in the mild group (70.3% vs. 82.8%, P = 0.012). Severe lymphopenia was also associated with a higher incidence of infection and a higher pretreatment neutrophil-to-lymphocyte ratio. HAEs were highly prevalent among patients receiving postoperative adjuvant CRT for cervical cancer, with lymphopenia occurring earliest and most frequently. Advanced FIGO stage, greater pelvic bone marrow exposure at V40, and previous neoadjuvant chemotherapy were independently associated with severe HAEs. Early risk assessment, bone marrow dose optimization, and individualized supportive management may help reduce severe hematological toxicity and treatment disruption.