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Management Options for Cancer Therapy-Related Anaemia

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Abstract

Anaemia is common in patients with haematological malignancy, occurring in the majority of patients with malignant disease who are treated with chemotherapy. Most patients will have their anaemia attributed to the cytokine-mediated anaemia of chronic disease. Many of these patients with anaemia will be symptomatic with fatigue, which is the single most important symptom reported. Data from many studies indicate that treatment of patients with anaemia with recombinant human erythropoietin (rHuEpo) will increase their haemoglobin level, decrease transfusion need and also improve their quality of life. Recent clinical and experimental work suggest that improving the haemoglobin level may improve the patients’ prognosis but this finding needs to be confirmed.

Treatment of anaemia with rHuEpo in patients with cancer may produce many benefits. Unfortunately, rHuEpo is effective in only around 60% of patients, is slow acting and is expensive. These drawbacks have restricted its use in many healthcare systems. However, a failure to treat anaemia may have important adverse effects for the patient both in terms of their quality of life and, just possibly, in terms of their life expectancy.

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References

  1. San Miguel JF, Garcia-Sanz R, Gonzalez M, et al. A new staging system for multiple myeloma based on the number of S-phase plasma cells. Blood 1995; 85(2): 448–55

    Google Scholar 

  2. Coiffier B. Anemia associated with non-platinum chemotherapy (CT) for Hodgkins lymphoma (HL) or non-Hodgkins lymphoma (NHL) [abstract]. European Cancer Conference (ECCO) 10 Programme 1999; 35: S19

    Google Scholar 

  3. Barrett-Lee PJ, Bailey NP, O’Brien MER, et al. Large scale UK audit of blood transfusion requirements and anaemia in patients receiving cytotoxic chemotherapy. Br J Cancer 2000; 82: 93–7

    Article  PubMed  CAS  Google Scholar 

  4. Groopman JE, Itri LM. Chemotherapy induced anemia in adults: incidence and treatment. J Natl Cancer Inst 1999; 91: 1616–34

    Article  PubMed  CAS  Google Scholar 

  5. Spivak JL. Recombinant human erythropoietin and the anaemia of cancer. Blood 1994; 84: 997–1004

    PubMed  CAS  Google Scholar 

  6. Miller CB, Jones RJ, Piantadosi S, et al. Decreased erythropoietin response in patients with the anemia of cancer. N Engl J Med 1990; 322(24): 1689–92

    Article  PubMed  CAS  Google Scholar 

  7. Cazzola M, Mercuriali F, Brugnara C. Use of recombinant erythropoietin outside the setting of uraemia. Blood 1997; 89: 4248–67

    PubMed  CAS  Google Scholar 

  8. Curt GA, Breithart W, Cella D, et al. Impact of cancer related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist 2000; 5: 353–60

    Article  PubMed  CAS  Google Scholar 

  9. Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. Semin Hematol 1997; 34Suppl. 2: 4–12

    PubMed  CAS  Google Scholar 

  10. Grogan M, Thomas GM, Melamed I, et al. The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer 1999; 86: 1528–36

    Article  PubMed  CAS  Google Scholar 

  11. Glaser C, Millesi W, Kornek GU, et al. Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharnyx. Int J Radiat Oncol Biol Phys 2001; 50: 705–15

    Article  PubMed  CAS  Google Scholar 

  12. Ludwig H, Fritz E, Kotzmann H, et al. Erythropoietin treatment of anemia associated with multiple myeloma. N Engl J Med 1990; 322: 1693–9

    Article  PubMed  CAS  Google Scholar 

  13. Cazzola M, Messinger D, Battistel V, et al. Recombinant human erythropoietin in the anaemia associated with multiple myeloma or non-Hodgkin’s lymphoma: dose finding and identification of the predictors of response. Blood 1995; 86: 4446–53

    PubMed  CAS  Google Scholar 

  14. Osterborg A, Boogaerts MA, Cimino R, et al. Recombinant human erythropoietin in transfusion-dependent anaemic patients with multiple myeloma and non-Hodgkin’s lymphoma-a randomised multicentre study. Blood 1996; 87: 2675–82

    PubMed  CAS  Google Scholar 

  15. Dammaco F, Castoldi G, Rodjer S. Efficacy of epoetin alfa in the treatment of anaemia of multiple myeloma. Br J Haematol 2001; 113: 172–9

    Article  Google Scholar 

  16. Glaspy J, Bukowski R, Steinberg D, et al. Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. J Clin Oncol 1997; 15(3): 1218–34

    PubMed  CAS  Google Scholar 

  17. Demetri GD, Kris M, Wade J, et al. Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a Prospective Community Oncology study. J Clin Oncol 1998; 16(10): 3412–25

    PubMed  CAS  Google Scholar 

  18. Gabrilove JL, Einhorn LH, Livingston RB, et al. Once-weekly dosing of Epoetin alpha is similar to three-times-weekly dosing in increasing haemoglobin and quality of life. J Clin Oncol 2001; 19(11): 2875–82

    PubMed  CAS  Google Scholar 

  19. Cleeland CS, Demetri GD, Glaspy J, et al. Identifying haemoglobin level for optimal quality of life: results of an incremental analysis [abstract]. Proc Am Soc Clin Oncol 1999; 18: 2215

    Google Scholar 

  20. Littlewood TJ, Bajetta E, Nortier JW, et al. Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 2001; 19: 2865–74

    PubMed  CAS  Google Scholar 

  21. Kelleher DK, Matthiensen U, Thews O, et al. Blood flow, oxygenation and bioenergetic status of tumors after erythropoietin treatment in normal and anemic rats. Cancer Res 1996; 56: 4728–34

    PubMed  CAS  Google Scholar 

  22. Molls M, Stadler P, Becker A, et al. Relevance of oxygen in radiationoncology: mechanisms of action, correlation to low hemoglobin levels. Strahlenther Onkol 1998; 174Suppl. IV: 13–6

    PubMed  Google Scholar 

  23. Teicher BA, Holden SA, Al-Achi A, et al. Classification of antineoplastic treatments by their differential toxicity toward putative oxygenated and hypoxic tumour subpopulations in vivo in the FSaIIC murine fibrosarcoma. Cancer Res 1990; 50: 3339–44

    PubMed  CAS  Google Scholar 

  24. Höckel M, Schlenger K, Hockel S, et al. Association between tumor hypoxia and malignant progression: the clinical evidence in cancer of the uterine cervix. In: Vaupel P, Kelleher DK, editors. Tumor hypoxia. Stuttgart; Wissenschaftliche Verlagsgesellschaft mbh, 1999: 65–74

    Google Scholar 

  25. Glaspy J, Bukowski R, Steinberg D, et al. Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. J Clin Oncol 1997; 15: 1218–34

    PubMed  CAS  Google Scholar 

  26. Glaspy J, Colowick A, Heatherington A. Novel erythropoiesis stimulating protein exhibits a prolonged serum half life (t1/2) in oncology patients [abstract]. Proc Am Soc Clin Oncol 2000; 19: 210

    Google Scholar 

  27. Ludwig H, Fritz E, Leitgeb C, et al. Prediction of response to erythropoietin treatment in chronic anaemia of cancer. Blood 1994; 84: 1056–63

    PubMed  CAS  Google Scholar 

  28. Macdougall IC, Cavill I, Hulme B, et al. Detection of functional iron deficiency during erythropoietin treatment: a new approach. Br Med J 1992; 304: 225–6

    Article  CAS  Google Scholar 

  29. Italian Cooperative Study Group for rHuEpo in Myelodysplastic Syndromes. A randomised double-blind placebo controlled study with subcutaneous recombinant human erythropoietin in patients with low risk myelodysplastic syndromes. Br J Haematol 1998; 103: 1070–4

    Google Scholar 

  30. Stein RS, Abels RI, Krantz SB. Pharmacologic doses of recombinant human erythropoietin in the treatment of myelodysplastic syndromes. Blood 1991; 78: 1658–63

    PubMed  CAS  Google Scholar 

  31. Hellstrom-Lindberg E. Efficacy of erythropoietin in the myelodysplastic syndromes: a meta-analysis of 205 patients from 17 studies. Br J Haematol 1995; 89: 67–71

    PubMed  CAS  Google Scholar 

  32. Negrin RS, Stein R, Vardiman J, et al. Treatment of the anaemia of myelodysplastic syndromes using recombinant human granulocyte colony stimulating factor in combination with erythropoietin. Blood 1993; 82: 737–43

    PubMed  CAS  Google Scholar 

  33. Hellstrom-Lindberg E, Ahlgren T, Beguin E, et al. Treatment of anaemia in myelodysplastic syndromes with granulocyte colony stimulating factor plus erythropoietin: results from a randomized phase II study and long term follow up of 71 patients. Blood 1998; 92: 68–75

    PubMed  CAS  Google Scholar 

  34. Mantovani L, Lentini G, Hentschel B, et al. Treatment of anaemia in myelodysplastic syndromes with prolonged administration of recombinant human granulocyte colony-stimulating factor and erythropoietin. Br J Haematol 2000; 109: 367–75

    Article  PubMed  CAS  Google Scholar 

  35. Hellstrom-Lindberg E, Negrin R, Stein R, et al. Erythroid response to treatment with G-CSF plus erythropoietin for the anaemia of patients with myelodysplastic syndromes: proposals for a predictive model. Br J Haematol 1997; 99: 344–51

    Article  PubMed  CAS  Google Scholar 

  36. Hellstrom-Lindberg E, Ahlgren T, Dahl I, et al. A final decision model for treating the anemian of myelodysplastic syndromes (MDS) with Epo and G-CSF [abstract]. Blood 2000; 96: 2347

    Google Scholar 

  37. Casadevall N, Nataf J, Viron B, et al. Pure red cell aplasia and anti erythropoietin antibodies in patients treated with recombinant erythropoietin. N Engl J Med 2002; 346: 469–75

    Article  PubMed  CAS  Google Scholar 

  38. Gershon SK, Luksenburg H, Cote TR, et al. Pure red-cell aplasia and recombinant erythropoietin [letter]. N Engl J Med 2002; 346: 1584–5

    Article  PubMed  Google Scholar 

  39. Bunn HF. Sugar in erythropoietin: clinical and forensic implications [comment]. Blood 2002; 99: 1503

    Article  PubMed  CAS  Google Scholar 

  40. Quirt I, Robeson C, Lau CY, et al. Epoetin alfa increases hemoglobin levels and improves quality of life in patients with cancer-related anemia who are not receiving chemotherapy and patients with anemia who are receiving chemotherapy. J Clin Oncol 2001; 19: 4126–34

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Dr Tim J. Littlewood is a paid consultant to one of the companies manufacturing recombinant human erythropoietin. No funding was used in the preparation of this manuscript.

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Littlewood, T.J. Management Options for Cancer Therapy-Related Anaemia. Drug-Safety 25, 525–535 (2002). https://doi.org/10.2165/00002018-200225070-00006

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