Why it is worth to consider use of erythropoiesis stimulating agents in anemia treatment of cancer patients? Review article

Article Sidebar

Requires Subscription PDF (Język Polski)


Published: Dec 31, 2016
Keywords:
cancer, anemia, blood transfusion

Main Article Content

Piotr Radziwon
Regionalne Centrum Krwiodawstwa i Krwiolecznictwa w Białymstoku, Klinika Hematologii, Uniwersytet Medyczny w Białymstoku

Abstract

Anemia in cancer patients is related to worse quality of live, delays and/or complicates start of chemo- or radiotherapy, increases tumor resistance to radiotherapy, presents negative prognostic factor, correlates with higher mortality risk. On the other hand, there is accumulating evidence for the presence of correlation between blood transfusions and worse survival, shortened recurrence free survival, recurrence related mortality rate, higher postoperative complication rate (incl. thrombo-embolic), prolonged hospital stay. The causes of these negative effects of blood transfusion might be: changes occurring during storage of red blood cells (RBC), immunogenicity of blood cells, presence of leukocytes and pathogens and human error. The definition of border line for anemia beneath that profits of blood transfusion outweigh the risk attributable to transfusion, presents significant clinical problem. In vast majority of patients with normovolemic anemia transfusion of red blood cells is not necessary if hemoglobin concentration is above 7 g/dl. However, in cancer patients the negative impact of anemia on disease progression, treatment and prognosis as well as on quality of life justify more intensive anemia treatment. The start of the treatment at hemoglobin concentration below 9 g/dl, and even below 10 g/dl, if there are clinical symptoms of anemia, is recommended. In order to cease symptoms of anemia prompt increase of Hb concentration by red blood cell concentrate transfusion is needed. Subsequently the possibility for further treatment with erythropoiesis stimulating agents (ESA) should be considered. The intended use of ESA is to reduce RBC transfusion requirements and to improve quality of live. ESA should be use in anemic cancer patients if Hb concentration decreases to less than 10–11 g/dl. In patients on ESA treatment Hb concentration must not exceed 12 g/dl. If ESA are contraindicated or ineffective, red blood cell concentrate should be transfused, however only in amount sufficient for cesation of anemia symptoms and aiming Hb concentration not higher than 9–10 g/dl. Safer preparations of red blood cell concentrates should be used – leukodepleted and occasionally irradiated, if patients are at risk of TA-GvHD.

Article Details

How to Cite
Radziwon, P. (2016). Why it is worth to consider use of erythropoiesis stimulating agents in anemia treatment of cancer patients?. Medycyna Faktow (J EBM), 9(4(33), 359-366. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2213
Issue
Vol 9 No 4(33) (2016)
Section
Articles

Copyright © by Medical Education. All rights reserved.

References

1. Bhide S.A., Ahmed M., Rengarajan V. et al.: Anemia during sequential induction chemotherapy and chemoradiation for head and neck cancer: the impact of blood transfusion on treatment outcome. Int. J. Radiat. Oncol. Biol. Phys. 2009; 73: 391-398.
2. Chau J.K., Harris J.R., Seikaly H.R.: Transfusion as a predictor of recurrence and survival in head and neck cancer surgery patients. J. Otolaryngol. Head Neck Surg. 2010; 39: 516-522.
3. Panagopoulos N.D., Karakantza M., Koletsis E. et al.: Influence of blood transfusions and preoperative anemia on long-term survival in patients operated for non-small cell lung cancer. Lung Cancer 2008; 62: 273-280.
4. Ling F.C., Hoelscher A.H., Vallböhmer D. et al.: Leukocyte depletion in allogeneic blood transfusion does not change the negative influence on survival following transthoracic resection for esophageal cancer. J. Gastrointest. Surg. 2009; 13: 581-586.
5. Yamamoto J., Kosuge T., Takayama T. et al.: Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 1994; 115: 303-309.
6. Brand A et al. AABB Press 1999: 145.
7. Schiergens T.S., Rentsch M., Kasparek M.S. et al.: Impact of perioperative allogeneic red blood cell transfusion on recurrence and overall survival after resection of colorectal liver metastases. Dis. Colon. Rectum 2015; 58: 74-82.
8. Amato A., Pescatori M.: Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst. Rev. 2006; (1): CD005033.
9. Vamvakas E.C.: Perioperative blood transfusion and cancer recurrence: meta-analysis for explanation. Transfusion 1995; 35: 760-768.
10. Thomas P., Michelet P., Barlesi F. et al.: Impact of blood transfusions on outcome after pneumonectomy for thoracic malignancies. Eur. Respir. J. 2007; 29: 565-570.
11. Kooby D.A., Stockman J., Ben-Porat L. et al.: Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann. Surg. 2003; 237: 860-869.
12. Cescon M., Vetrone G., Grazi G.L. et al.: Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann. Surg. 2009; 249: 995-1002.
13. Sarani B., Dunkman W.J., Dean L. et al.: Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection. Crit. Care Med. 2008; 36: 1114-1118.
14. Castillo J.J., Dalia S., Pascual S.K.: Association between red blood cell transfusions and development of non-Hodgkin lymphoma: a meta-analysis of observational studies. Blood 2010; 116: 2897-2907.
15. Al-Refaie W.B., Parsons H.M., Markin A. et al.: Blood transfusion and cancer surgery outcomes: a continued reason for concern. Surgery 2012; 152: 344-354.
16. Hjalgrim H., Edgren G., Rostgaard K. et al.: Cancer incidence in blood transfusion recipients J. Natl. Cancer Inst. 2007; 99: 1864-1874.
17. Riedl R., Engels E.A., Warren J.L. et al.: Blood transfusions and the subsequent risk of cancers in the United States elderly. Transfusion 2013; 53: 2198-2206.
18. Blajchman M.A.: Immunomodulation and blood transfusion. Am. J. Ther. 2002; 9: 389-395.
19. Jensen L.S., Andersen A.J., Christiansen P.M. et al.: Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br. J. Surg. 1992; 79: 513-516.
20. Ydy L.R., Slhessarenko N., de Aguilar-Nascimento J.E.: Effect of perioperative allogeneic red blood cell transfusion on the immune-inflammatory response after colorectal cancer resection. World J. Surg. 2007; 31: 2044-2051.
21. Del Mastro L., Venturini M., Lionetto R. et al.: Randomized phase III trial evaluating the role of erythropoietin in the prevention of chemotherapy- induced anemia. J. Clin. Oncol. 1997; 15: 2715-2721.
22. Ansari S., Szallasi A.: Wrong blood in tube: solutions a persistent problem. Vox. Sang. 2011; 100: 298-302.
23. McIntyre L.A., Fergusson D.A., Hutchison J.S. et al.: Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury. Neurocrit. Care 2006; 5: 4-9.
24. Hebert P.C., McDonald B.J., Tinmouth A.: Clinical consequences of anemia and red cell transfusion in the critically ill. Crit. Care Clin. 2004; 20: 225-235.
25. Ludwig H., Van Belle S., Barrett-Lee P. et al.: The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur. J. Cancer 2004; 40: 2293-2306.
26. Wojtukiewicz M.Z., Sierko E., Rybałtowski M. et al.: The Polish Cancer Anemia Survey (POLCAS): a retrospective multicenter study of 999 cases. Int. J. Hematol. 2009; 89: 276-284.
27. Blohmer J.U., Dunst J., Harrison L. et al.: Cancer-related anemia: biological findings, clinical implications and impact on quality of life. Oncology 2005; 68(supl. 1): 12-21.
28. Spivak J.L., Gascon P., Ludwig H.: Anemia management in oncology and hematology. Oncologist 2009; 14(supl. 1): 43-56.
29. Rizzo J.D., Brouwers M., Hurley P. et al.: American Society of Clinical Oncology/American Society of Hematology Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin in Adult Patients With Cancer 2010. J. Oncol. Pract. 2010; 6(6): 317-320.
30. Korsak J., Baranowski W., Jung A. et al. (red.): Wytyczne w zakresie leczenia krwią i jej składnikami oraz produktami krwiopochodnymi w podmiotach leczniczych. Wydanie II. Wojskowy Instytut Medyczny, Warszawa 2014.
31. Rodgers G.M., Becker P.S., Blinder M. et al.: Cancer- and Chemotherapy-Induced Anemia. J. Natl. Compr. Canc. Netw. 2012; 10: 628-653.
32. Schrijvers D., De Samblanx H., Roila F.; ESMO Guidelines Working Group: Erythropoiesis-stimulating agents in the treatment of anaemia in cancer patients: ESMO Clinical Practice Guidelines for use. Ann. Oncol. 2010; 21(supl. 5): v244-v247.
33. Aapro M., Moebus V., Nitz U. et al.: Safety and efficacy outcomes with erythropoiesis-stimulating agents in patients with breast cancer: a meta- analysis. Ann. Oncol. 2015; 26: 688-695.
34. Tonia T., Mettler A., Robert N. et al.: Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst. Rev. 2012; (3): CD003407.
35. Li X., Yan Z., Kong D. et al.: Erythropoiesis-stimulating agents in the management of cancer patients with anemia: a meta-analysis. Chin. J. Cancer Res. 2014; 26: 268-276.
36. van de Watering L.M., Brand A., Houbiers J.G. et al.: Perioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence. Br. J. Surg. 2001; 88: 267-272.