Early intervention for chemotherapy-induced anaemia beneficial

Erythropoietic treatment for chemotherapy-induced anemia reduces the need for transfusions and improves quality of life if initiated for mild, Grade 1 anaemia, investigators report.

Practice guidelines for the management of chemotherapy-induced anemia issued by the American Society of Clinical Oncology and the American Society of Hematology recommend the use of erythropoietic agents in patients with hemoglobin below 10 g/dL. They have no definitive recommendation for patients with Grade 1 anaemia (hemoglobin 10 g/dL or higher).However, the National Comprehensive Cancer Network recommends erythropoietic intervention in cancer patients with hemoglobin of 11 g/dL or less.Dr. Gary H. Lyman, from the University of Rochester Medical Center in New York, and Dr. John Glaspy, from the University of California Los Angeles School of Medicine, systematically reviewed published literature and meeting abstracts to identify randomized controlled trials of recombinant human erythropoietin (rHuEPO) for Grade 1 anaemia.According to their report in the January 1st issue of Cancer, they identified seven prospective randomized clinical trials of treatment with rHuEPO versus no treatment or placebo when baseline hemoglobin concentration was 10 g/dL or higher. The proportion of patients requiring transfusion across the seven trials was 22.5% among those randomized to receive rHuEPO and 41.3% among control patients. The weighted summary relative risk of a transfusion associated with rHuEPO was 0.50 (p < 0.0001).The proportion of patients a fall in hemoglobin to < 10 g/dL followed a similar pattern: 21.2% versus 52.6%, respectively, RR 0.40 (p = 0.0147). A similar benefit was observed in five clinical trials when rHuEPO was instituted before hemoglobin fell below 10.0 or if it was held back until later, with transfusion rates of 14.3% versus 25.6% (RR 0.55, p = 0.0001).Moreover, Drs. Lyman and Glaspy add, "studies examining the impact of erythropoietic treatment on health-related quality of life (HRQOL) have demonstrated that early intervention not only ameliorates anaemia symptoms but also offers significant improvements in HRQOL and productivity compared with initiating treatment only when anaemia becomes more severe."They therefore suggest appropriately powered studies to prospectively assess transfusion reduction and HRQOL improvement in specific patient populations, as well as assessments of the relative cost effectiveness of early interventions.(Source: Cancer 2006;106:223-233: Reuters Health: Oncolink: February 2006.)