Anaemia management update: blood transfusion and ESA use in oncology

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Published: 15 Dec 2011
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Prof Matti Aapro, Prof Valeria Santini, Dr Joachim Fandrey, Dr Richard Delarue and Prof Donat Spahn

The panel discuss the evidence that erythropoiesis-stimulating agents (ESAs) such as erythropoietins (EPOs) could help treat anaemia in myelodysplastic syndrome (MDS). Predictive factors for patient response have previously been limited to transfusion dependence and haemoglobin levels. However, recent research suggests that biological indicators such as signal transduction and myeloblast phenotyping could improve patient selection. The panel outline how potential adverse effects such as thromboembolic events can be managed and speak about the attempts to identify EPO receptors in tumour tissues.

 

Two important trials are looking at anaemia in lymphoma are discussed. A recent study by the German Hodgkin’s Lymphoma Study Group, the HD15-EPO trial, demonstrated that adding epoetin alpha to standard chemotherapy for patients with advanced-stage Hodgkin’s lymphoma resulted in a reduction in the number of red blood cell transfusions whilst not having a negative impact on fatigue or survival. The second trial revealed that prophylactic darbepoetin alpha can be used to maintain haemoglobin levels in elderly patients with diffuse large B-cell lymphoma. This treatment was associated with an increase in progression and disease free survival and although there were associated thromboembolic complications, these did not lead to patient deaths.

 

The panel conclude by considering blood transfusions and warning that although lifesaving in cases of major blood loss, this procedure is not as safe as once thought and may not be beneficial to the majority of patients.

 

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).