Treating Mild Anemia

One of the most common side effects of chemotherapy is the lowering of blood counts (immunosuppression). Chemotherapy can reduce the normal functioning of the bone marrow, where most blood cells are produced. This can result in anemia, fatigue, and an increased risk of infection, among other side effects.

If anemia-related blood counts become dangerously low, a blood transfusion may be necessary. This results in an immediate boost to blood counts, but it is expensive, inconvenient, and dependent on available community blood supplies. A preferable alternative is the use of drugs called "growth factors" that stimulate the bone marrow to produce more blood cells.

The body naturally produces hormone-like substances called hematopoietic (blood forming) growth factors that cause the bone marrow to make more blood cells. However, unlike transfusions, these growth factors take several days to raise blood counts.

One of the most common growth factors used to treat mild anemia is erythropoietin (epoetin alfa, Procrit), which promotes production of red blood cells. And a pair of new studies have confirmed its usefulness.

Most recently, Dr. Jerome Seidenfeld of the Blue Cross and Blue Shield Association in Chicago and colleagues found that epoetin treatment in cancer patients significantly reduces the need for transfusions, although the researchers were unsure at what point epoetin should be given.

Seidenfeld's team reviewed 22 clinical trials involving epoetin that took place between 1985 and 1998. They wanted to compare patients with chemotherapy-associated anemia who received epoetin treatment with patients who received blood transfusions.

Writing in the Journal of the National Cancer Institute, they reported that patients given epoetin for mild anemia significantly reduced their eventual need for a blood transfusion. However, they cautioned that the results were inconclusive about the best timing for giving the treatment.

"Evidence is insufficient to determine whether initiating epoetin earlier spares more patients from transfusion than waiting until the hemoglobin concentration declines to nearly 10g/dL," they wrote.

In a second study, Dr. Timothy Littlewood of John Radcliffe Hospital in Oxford, England and colleagues found that patients who used epoetin alfa had significantly more energy and an increased ability to perform daily activities compared to patients who used a placebo.

Writing in the Journal of Clinical Oncology, they further noted that fewer patients using epoetin alfa required blood transfusions compared to the placebo group-28 percent vs. 40 percent-after the first month of treatment.

"This is a very safe drug. There is no reason not to give anemic chemotherapy patients epoetin alfa to improve their quality of life," concluded Littlewood. He added that this study was important because it evaluated the additional use of epoetin alfa with non-platinum chemotherapies, which represent the majority of chemotherapy drugs.

SOURCES:
Journal of the National Cancer Institute, August 15, 2001; 93:1204-1214
Journal of Clinical Oncology, June 2001; 19:11, 2865-2874

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