Which anticancer drug class commonly causes bone marrow suppression and what is a typical nursing action?

• A. Alkylating agents; CBC frequently
• B. Antimetabolites; CBC weekly
• C. Hormonal therapy; monitor CBC
• D. Immunotherapy; monitor CBC

Answer: (A)

Bone marrow suppression is a common toxicity of many cytotoxic anticancer drugs, because these agents target rapidly dividing cells, including hematopoietic cells. Alkylating agents work by causing cross-links in DNA, which broadly affects dividing cells and leads to myelosuppression. A typical nursing action is to monitor complete blood counts frequently—often before each treatment and around the expected nadir—to detect neutropenia, anemia, and thrombocytopenia early. This allows timely dose adjustments, treatment delays if needed, and implementation of supportive care and precautions (infection prevention, bleeding precautions). While antimetabolites can also cause myelosuppression, hormonal therapies and many immunotherapies have different toxicity profiles, so the focus on frequent CBC monitoring is the most characteristic response to the marrow-suppressive risk associated with alkylating agents.