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Evidence Shows Epoetin Reduces Transfusions in Anemic Cancer Patients but Questions Remain on How Best to Use It

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Research Alert: May 1, 2001

Epoetin alfa, a synthetic hormone developed to replace the natural hormone erythropoietin, reduces the need for transfusions in cancer patients with chemotherapy-induced anemia, according to a report released today by the Agency for Healthcare Research and Quality (AHRQ). The study finds that evidence that epoetin reduces the need for transfusions is strongest when epoetin is initiated as declining hemoglobin (Hb) levels near 10 g/dL. Analysis of the pooled evidence estimated that one in five patients who would have required a transfusion, will not when treated with epoetin. The analysis was conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) sponsored by AHRQ.

The EPC found that many questions remain to be answered about how to use epoetin. Randomized controlled trials are needed to determine whether initiating treatment at baseline Hb levels greater than 10 g/dL provides additional benefits in reducing the need for transfusions or improving quality of life. More research is needed on how to predict which patients respond to epoetin and to determine the most efficient doses and schedules. The report also makes recommendations for improving the quality of future studies.

Patients with certain hematologic malignancies, such as multiple myeloma, non-Hodgkin's lymphoma, chronic lymphocytic leukemia, and myelodysplastic syndromes, are at risk for anemia as a direct result of their disease. Although there is not a substantial amount of information available, the evidence does suggest that epoetin is likely to reduce the need for transfusions in patients with these hematologic malignancies. Patients with myelodysplastic syndrome are less likely to respond to epoetin and may require higher doses to achieve the same results.

The summary of the EPC findings, Uses of Epoetin for Anemia in Oncology, Evidence Report/Technology Assessment is available online at and from the National Guideline Clearinghouse™ (NGC) (select NGC Resources). Printed copies are available from the AHRQ Publications Clearinghouse at or by calling 1-800-358-9295.

For more information, please contact AHRQ Public Affairs, (301) 427-1364: Karen Migdail, (301) 427-1855 (


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