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Epoetin may reduce the need for transfusion in cancer patients undergoing chemotherapy or radiation

Erythropoietin is a hormone produced primarily in the kidney, which has been shown to increase red blood cell counts and hemoglobin concentrations in many patients with anemia caused by cancer therapy (chemotherapy or radiation). Two forms of recombinant human erythropoietin, known generically as "epoetin alfa" and "epoetin beta" were developed in the 1980s and used initially to treat anemia associated with end-stage renal disease.

A recent review of the available scientific evidence found that subcutaneous injections of epoetin reduce the odds of transfusion of red blood cells to manage the anemia of patients undergoing cancer treatment. However, better quality studies reported smaller effects. There was insufficient evidence to determine whether initiating epoetin treatment earlier would spare more patients from transfusion or result in better quality of life than waiting until hemoglobin concentrations decline to nearly 10g/dL (mild anemia).

These are the conclusions detailed in a report from the Blue Cross and Blue Shield Association Technology Evaluation Center, which is an Evidence-based Practice Center supported by the Agency for Healthcare Research and Quality (contract 290-97-0015). The meta-analysis of 12 studies, led by Jerome Seidenfeld, Ph.D., of the Blue Cross and Blue Shield Association, showed that epoetin decreased the percentage of cancer patients transfused by 9 to 45 percent in adults with mean baseline hemoglobin of 10 g/dL or less (seven studies); by 7 to 47 percent in those with hemoglobin between 10 and 12 g/dL (seven studies), and by 7 to 39 percent in those with hemoglobin 12 g/dL or more (five studies).

Overall, epoetin-treated patients had 55 percent less odds of transfusion (odds ratio, OR 0.45) in higher quality studies and 86 percent less odds (OR 0.14) in lower quality studies. The number of patients who needed to be treated to prevent one transfusion was 4.4 for all studies, 5.2 for higher quality studies, and 2.6 for lower quality studies. These findings suggest that epoetin can be used to treat mild anemia associated with cancer therapy. However given the cost of epoetin treatment, estimated at $3,700 to $6,600 per chemotherapy cycle, the researchers call for double-blind, randomized controlled trials of adequate power to better gauge the clinical value of epoetin on transfusion risk in cancer patients with anemia.

More details are in "Epoetin treatment for anemia of cancer therapy: A systematic review and meta-analysis of controlled clinical trials," by Dr. Seidenfeld, Margaret Piper, Ph.D., M.P.H., Carole Flamm, M.D., M.P.H., and others, in the August 15, 2001 Journal of the National Cancer Institute 93(16), pp. 1204-1214.

Editor's Note: Copies of the evidence report from which this journal article is drawn are available from the AHRQ Publications Clearinghouse. Request Use of Epoetin for Anemia in Oncology (AHRQ Publication No. 01-E009), Evidence Report Technology Assessment No. 30. A summary of the report (AHRQ Publication No. 01-E008) is also available.

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