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Transfusion practice patterns in patients with anemia receiving myelosuppressive chemotherapy for nonmyeloid cancer: results from a prospective observational study. Support Care Cancer 2018; 26:2031-2038. [PMID: 29349622 PMCID: PMC5919983 DOI: 10.1007/s00520-017-4035-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/28/2017] [Indexed: 01/28/2023]
Abstract
Purpose The decision to prescribe packed red blood cell (PRBC) transfusions in patients with chemotherapy-induced anemia (CIA) includes assessment of clinical features such as the patient’s cancer type and treatment regimen, severity of anemia symptoms, and presence of comorbidities. We examined contemporary transfusion practices in patients with nonmyeloid cancer and CIA. Methods Key inclusion criteria were age ≥ 18 years with nonmyeloid cancer, receiving first/second-line myelosuppressive chemotherapy, baseline hemoglobin (Hb) ≤ 10.0 g/dL, and planned to receive ≥ 1 PRBC transfusions. Exclusion criteria were receipt of erythropoiesis-stimulating agents within 8 weeks of screening and/or chronic renal insufficiency. Data were collected from patients’ medical records, laboratory values, and physician/provider questionnaires. Proportion of patients for each clinical consideration leading to a decision to prescribe a PRBC transfusion and 95% exact binomial confidence intervals were determined. Results The study enrolled 154 patients at 18 sites in USA; 147 (95.5%) received a PRBC transfusion. Fatigue was the most common symptom affecting the decision to prescribe a PRBC transfusion (101 [69.2%] patients). Of the three reasons selected as primary considerations for prescribing a PRBC transfusion, anemia symptoms (106 [72.1%] patients) was the most frequently reported, followed by Hb value (37 [25.2%] patients) and medical history (4 [2.7%] patients). Conclusions In this study, the primary consideration for prescribing a PRBC transfusion was anemia symptoms in 72.1% of patients, with only 25.2% of patients prescribed a transfusion based exclusively on Hb value. Results indicate that clinical judgment and patient symptoms, not just Hb value, were used in decisions to prescribe PRBC transfusions. Electronic supplementary material The online version of this article (10.1007/s00520-017-4035-7) contains supplementary material, which is available to authorized users.
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Rosti G, Petrini M, Bosi A, Galieni P, Bernardi D, Giglio G, Dorotea L, Falini B, Scelzi E, Veltri E, Castelli R, Longagnani C, Raggi T, Simonetti F. Management of anaemia in oncohaematological patients treated with biosimilar epoetin alfa: results of an Italian observational, retrospective study. Ther Adv Med Oncol 2017; 9:22-32. [PMID: 28203295 PMCID: PMC5298451 DOI: 10.1177/1758834016670554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many patients with solid tumours or nonmyeloid haematopoietic tumours develop symptomatic anaemia, which has a major impact on quality of life (QoL). The efficacy of erythropoiesis-stimulating agents (ESAs) in improving QoL and reducing blood transfusions has been widely demonstrated. Binocrit® (biosimilar epoetin alfa) is an ESA indicated in the European Union for treating chemotherapy-induced anaemia. The aim of this study was to investigate the effect of Binocrit® on haemoglobin (Hb) levels in anaemic cancer patients in Italian clinical practice. METHODS The ANEMONE study was a national, longitudinal, retrospective, multicentre observational study. Patients had to be 18 years or older, with a solid tumour or non-Hodgkin's lymphoma, Hodgkin's disease or multiple myeloma, receiving chemotherapy, and treated with Binocrit® to manage chemotherapy-induced anaemia. The primary outcomes were the proportion of patients with a Hb increase ⩾1 g/dl during the first 4 weeks and with a Hb increase ⩾2 g/dl during the first 12 weeks. RESULTS A total of 245 patients were enrolled and 215 patients were evaluable for statistical analysis. In the first 4 weeks, 49.3% of patients showed an increase in Hb of ⩾1 g/dl: 45.5% in patients with solid tumours and 52.1% in patients with haematological malignancies. In the first 12 weeks, 51.6% of patients showed an increase in Hb of ⩾2 g/dl (48.4% solid tumours, 54.2% haematological diseases). Treatment with Binocrit® was well tolerated. CONCLUSIONS These results confirm the effectiveness and safety of Binocrit® for chemotherapy-induced anaemia in routine practice in patients with solid tumours, lymphoma and myeloma.
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Affiliation(s)
- Giovanni Rosti
- Oncologia, Policlinico San Matteo IRCCS, Pavia, Via Scarpa 1, 31100 Treviso, Italy
| | - Mario Petrini
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alberto Bosi
- Department of Hematology, Careggi Hospital and University of Florence, Firenze, Italy
| | | | | | | | | | | | - Elvira Scelzi
- Ospedale di Castelfranco Veneto (ULSS), Castelfranco Veneto, Italy
| | | | - Roberto Castelli
- Fondazione Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
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Abraham I, MacDonald K, Tharmarajah S, Bokemeyer C, Ludwig H, Soubeyran P, Battistel V, Aapro M. Modeling of treatment response to erythropoiesis-stimulating agents in older (age≥70years) and younger (age<70years) patients with cancer and anemia: findings from the Anemia Cancer Treatment study. J Geriatr Oncol 2013; 4:196-201. [PMID: 24071545 DOI: 10.1016/j.jgo.2012.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 08/17/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The Anemia Cancer Treatment study assessed hemoglobin (Hb) outcomes following treatment with erythropoiesis-stimulating agents (ESA) in anemic (Hb≤11g/dL) patients in Europe. We replicated the original analyses stratifying by age, namely patients aged ≥70 (n=637) versus those aged<70 (n=1555). MATERIALS AND METHODS A secondary analysis of Hb outcomes was assessed over 8-10weeks. Treatment response criteria included increases of Hb≥1g/dL, Hb≥1g/dL over 8weeks, and Hb≥2g/dL over the course of the study period. RESULTS Mean Hb increased from similar levels of 9.5g/dL [p=not significant (ns)] at visit one to 10.9g/dL (p=ns) at visit three (both p<0.001). Patients aged≥70 had higher mean Hb at visit two (10.6g/dL vs. 10.3g/dL, p<0.001). Cohorts did not differ in treatment response rates (all p=ns). Mean performance status differed between cohorts at each visit (all p≤0.011); both groups showed significant improvements (both p<0.001). Immediacy of response was a consistent determinant but was more pronounced among patients aged≥70. Less consistent determinants included performance status in the age≥70 group, as well as hematological malignancy and Hb at ESA start in the age<70 group. The proportion of variance in Hb outcomes attributable to treatment center ranged from 0.090 to 0.289 in the age≥70 cohort and 0.126 to 0.361 in the age<70 cohort. CONCLUSIONS Both groups achieved similar Hb levels with the age≥70 cohort showing a higher initial evolution rate and potentially a different Hb response trajectory. Patients age≥70 were more likely to benefit from ESAs if showing an early erythropoietic response and exhibiting no or little impairment in performance status. Differential attribution of variability in older vs. younger adults suggests that individualization of ESA therapy may facilitate Hb response in geriatric patients with cancer.
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Affiliation(s)
- Ivo Abraham
- Center for Health Outcomes and Pharmacoeconomic Research, and Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Matrix45, Tucson, AZ, USA.
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Steegmann JL, Sánchez Torres JM, Colomer R, Vaz Á, López J, Jalón I, Provencio M, González-Martín A, Pérez M. Prevalence and management of anaemia in patients with non-myeloid cancer undergoing systemic therapy: a Spanish survey. Clin Transl Oncol 2013; 15:477-83. [PMID: 23263906 PMCID: PMC3663988 DOI: 10.1007/s12094-012-0953-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/01/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The present study aimed to provide updated data on anaemia prevalence and management in cancer patients undergoing systemic therapy in Spain. METHODS This was a multicenter, observational, cross-sectional study performed in 2008. Eligible patients were ≥18 years, with non-myeloid malignancies treated with systemic therapy [chemotherapy (CT), hormonal therapy or immunotherapy]. Anaemia was defined according to WHO as haemoglobin (Hb) < 12 g/dL. RESULTS The study included 214 patients with a median age of 63 years (range 20-91), 58 % women, 73 % with solid tumours, and 79 % with advanced disease. CT was used in 91 % of patients (26 % with platinum compounds), hormonal therapy in 8.5 %, and immunotherapy in 8.5 %. In our study, 48.1 % of patients [95 % confidence interval (CI) 45.2-58.6] showed anaemia (31 % symptomatic): 42.0 % mild (10 ≤ Hb ≤ 11.9 g/dL), 5.6 % moderate (8 ≤ Hb ≤ 9.9 g/dL), and 0.5 % severe (Hb < 8 g/dL). A higher prevalence was observed in patients treated with CT (51 vs. 20 %, p = 0.01), platinum-based CT (70 vs. 47 %, p = 0.01) or palliative CT (61 vs. 39 %, p = 0.003). Anaemia was also more frequent in patients with more than three lines of CT (83 %) and in the fourth or subsequent CT cycle (58 %). Management in the previous 4 weeks in patients with anaemia was: 62 % did not receive treatment (92 % mild), 24 % received erythropoiesis-stimulating agents (ESAs), 14 % received iron and 8.7 % received transfusion. CONCLUSIONS In Spanish hospitals, about half of patients with non-myeloid malignancies undergoing systemic therapy fulfilled anaemia criteria (87 % mild). Approximately two-third of patients with anaemia do not receive specific treatment and ESA use is below current guidelines.
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Affiliation(s)
- J L Steegmann
- Servicio de Hematología, Hematology Department, Instituto de Investigación Sanitaria (IIS-IP), Hospital Universitario de la Princesa, Diego de Leon, 62, 28006, Madrid, Spain.
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Michallet M, Goldet K, Sobh M, Morisset S, Chelghoum Y, Thomas X, Barraco F, Ducastelle S, Labussière H, Renzullo C, Paillet C, Pivot C, Straaten PBV, Denis A, Termoz A, Detrait M, Nicolini FE, Jaisson-Hot I. Prospective study of erythropoietin use on quality of life and cost effectiveness in acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation patients. Cancer 2012; 119:107-14. [DOI: 10.1002/cncr.27686] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/05/2012] [Accepted: 04/16/2012] [Indexed: 01/19/2023]
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Naeim A, Friedman L, Whitlock KB, Pasta DJ, Elkin EP, Lubeck DP, Viswanathan HN, Glaspy J. Patterns of care in community-based oncology practices for anemia associated with myelosuppressive chemotherapy. J Oncol Pract 2010; 5:236-43. [PMID: 20856735 DOI: 10.1200/jop.091011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2009] [Indexed: 11/20/2022] Open
Abstract
Use of erythropoiesis-stimulating agents in the treatment of myelosuppresive chemotherapy-induced anemia has been shown to increase hemoglobin levels and reduce the need for transfusions in patients with cancer.
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Affiliation(s)
- Arash Naeim
- University of California Los Angeles, Los Angeles; McKesson Specialty Care Solutions, San Rafael; ICON Clinical Research, Lifecycle Sciences Group, San Francisco; and Amgen, Thousand Oaks, CA
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Venturino A, Colloca G. Erythropoiesis-stimulating agents (ESAs), from chemotherapy-induced anemia to any cancer-related anemia? Ann Oncol 2010; 21:905-906. [DOI: 10.1093/annonc/mdp582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lal LS, Raju A, Miller LA, Chen H, Arbuckle R, Sansgiry SS. Impact of changes in reimbursement policies and institutional practice algorithm for utilization of erythropoietic-stimulating agents on treatment patterns and costs in anemic lymphoma patients. Support Care Cancer 2010; 19:251-9. [PMID: 20101414 DOI: 10.1007/s00520-009-0811-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Lincy Subha Lal
- Division of Pharmacy, Unit 90, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Aapro M, Ludwig H, Bokemeyer C, MacDonald K, Soubeyran P, Turner M, Albrecht T, Abraham I. Modeling of treatment response to erythropoiesis-stimulating agents as a function of center- and patient-related variables: results from the Anemia Cancer Treatment (ACT) study. Ann Oncol 2009; 20:1714-21. [DOI: 10.1093/annonc/mdp063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Ludwig H, Aapro M, Bokemeyer C, Macdonald K, Soubeyran P, Turner M, Albrecht T, Abraham I. Treatment patterns and outcomes in the management of anaemia in cancer patients in Europe: findings from the Anaemia Cancer Treatment (ACT) study. Eur J Cancer 2009; 45:1603-15. [PMID: 19278851 DOI: 10.1016/j.ejca.2009.02.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 01/23/2009] [Accepted: 02/02/2009] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine anaemia management in cancer patients treated with erythropoiesis-stimulating agents (ESAs) in Europe. METHODS Retrospective pharmacoepidemiologic study of 2192 patients from 307 centres. Minimum of 3 visits over 8-10 weeks with ESA treatment initiated at visit 1. RESULTS Most patients were treated per guidelines, except for low iron supplementation rates. Mean Hb rose from 9.54+/-0.95 g/dl to 10.88+/-1.49 g/dl at visit 3, without concomitant rise in WHO/ECOG score. Response rates were 65.0% (Hb increase (upward arrow) > or = 1 g/dl); 54.3% (Hb increase (upward arrow) > or = 1 g/dl in 8 weeks); 38.9% (haematopoietic response); 33.7% (Hb increase (upward arrow) > or = 2 g/dl) and 18.8% (Hb between 12.0 and 12.9 g/dl) CONCLUSIONS Treatment patterns were guideline congruent, except for (intravenous) iron supplementation. Hb increased by 1.34 g/dl. A net erythropoiesis boost of Hb > or =1 g/dl is attainable in two-thirds of patients and should be condensed to 8 weeks on an individual patient basis. Anaemia management in Europe has improved significantly. The general effectiveness and relative safety of judicious ESA treatment are evident.
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Affiliation(s)
- Heinz Ludwig
- Medizinische Abteilung I - Onkologie und Haematologie, Wilhelminenspital, Montleartstrasse 37, Wien 1160, Austria
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Sanz Ortiz J. Predictors of response to erythropoiesis-stimulating agents (ESA) in cancer patients: the role of baseline serum epoetin level. Clin Transl Oncol 2008; 10:486-92. [PMID: 18667379 DOI: 10.1007/s12094-008-0237-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Anemia is the most frequent hematologic abnormality among cancer patients. Its pathophysiology comprises reduction in erythrocyte half-life, poor iron reutilization by the bone marrow, and inadequate response to erythropoietin (EPO), with reduced endogenous EPO (eEPO) levels. Current treatment implies the use of erythropoiesis- stimulating agents (ESA), to which 35-48% of patients show primary resistance. The search for predictors of response to ESA treatment has been inconclusive. Iron or vitamin deficiency, the recent need for transfusion, or a lack of hemoglobin increase within the first 2-4 weeks usually predict resistance to ESA. High serum eEPO levels at treatment initiation (>100-150 mU/ml) may also predict resistance, especially in hematologic malignancies, but the results in solid tumors are not consistent. Although patients with cancer-related anemia show higher eEPO levels than patients without anemia, there is extreme variability among individuals. Future studies are needed to clarify eEPO usefulness in predicting response to ESA treatment.
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Affiliation(s)
- Jaime Sanz Ortiz
- Medical Oncology Service, Hospital Marqués de Valdecilla, Santander, Spain.
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Aapro MS, Link H. September 2007 update on EORTC guidelines and anemia management with erythropoiesis-stimulating agents. Oncologist 2008; 13 Suppl 3:33-6. [PMID: 18458123 DOI: 10.1634/theoncologist.13-s3-33] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anemia is frequently experienced by cancer patients receiving chemotherapy and can negatively impact the patient's prognosis. Blood transfusions, iron supplementation (in absolute or functionally iron-deficient anemias), and erythropoiesis-stimulating agents (ESAs) are among the treatment options for anemia. Treatment options for anemia management should be selected based on the best benefit-to-risk ratio for each individual patient. In September 2007, the working party of the European Organization for Research and Treatment of Cancer (EORTC) updated their guidelines on the use of ESAs, which are summarized in this paper. ESAs reduce the number of transfusions required and significantly improve quality of life in patients with chemotherapy-induced anemia. A sustained hemoglobin level of about 12 g/dl should be the target for treatment with ESAs. ESAs should be used according to the EORTC guidelines and within label with carefully considered exceptions.
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Affiliation(s)
- Matti S Aapro
- Multidisciplinary Oncology Institute, Genolier, Switzerland.
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Salzwimmer M. Best Supportive Care bei Patienten mit Kopf-Hals-Tumoren. Wien Med Wochenschr 2008; 158:278-82. [DOI: 10.1007/s10354-008-0534-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 04/10/2008] [Indexed: 10/21/2022]
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