The American Society of Clinical Oncology (ASCO) and the
American Society of Hematology (ASH) have updated their clinical guideline for
the use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. The
guideline also advises blood transfusion as a treatment option in these
patients.
Some key recommendations are:
·
ESAs may be offered to
patients with chemotherapy-associated anemia whose cancer treatment is not
curative in intent and hemoglobin (Hb) is < 10 g/dL.
·
Do not offer ESAs for
chemotherapy-associated anemia to patient in whom cancer treatment is curative
in intent.
·
ESAs should not be considered
for nonchemotherapy-associated anemia except for selected patients with
myelodysplastic syndromes (those with lower risk myelodysplastic syndromes and
a serum erythropoietin level ≤ 500 IU/L).
·
Before considering an ESA,
observe the hematologic response to cancer treatment in patients with myeloma,
non-Hodgkin lymphoma, or chronic lymphocytic leukemia.
·
First rule out other causes of
anemia or an underlying hematopoietic malignancy.
·
Epoetin beta and alfa,
darbepoetin and biosimilar epoetin alfa are comparable in effectiveness and
safety.
·
During ESA treatment, Hb may
be increased to the lowest level required to avoid transfusions.
·
Discontinue ESAs if no
response is evident within 6 to 8 weeks and re-evaluate the patient.
·
Iron replacement may be used
to improve Hb response and reduce RBC transfusions for patients receiving ESA
with or without iron deficiency.
(Source: Journal of Clinical Oncology. Published online
April 10, 2019)
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
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