Evaluation of the effect of routine packed red blood cell transfusion in anemic cervix cancer patients treated with radical radiotherapy

16002 Background: Epoetin alfa (EPO) and darbepoetin alfa (DARB) are used to treat cancer-related anemia and to reduce the requirements for blood transfusions. To date, limited information on the relative effectiveness of these agents in the inpatient setting is available. This analysis evaluated red blood cell (RBC) transfusion rates in cancer patients receiving EPO or DARB during hospitalization. Methods: An analysis of electronic inpatient hospital records from the Premier Perspective Comparative Hospital Database was conducted to compare RBC transfusion rates in cancer patients receiving EPO or DARB therapy. Study subjects were identified through hospitalizations recorded between 07/2002 and 03/2005 from over 500 hospitals nationwide. Patients were required to be ≥18 years old, have a primary admitting diagnosis of cancer and be treated with EPO or DARB during hospitalization. Patients who had received renal dialysis were excluded. To minimize effects of outliers, 5% of patients with extreme doses in each group were excluded from the dosing analysis. In addition to descriptive statistics on transfusion requirements, a multivariate logistic model was employed to isolate the effect of an individual erythropoietic agent on the risk of RBC transfusion after controlling for patient demographics, comorbidities, admission characteristics, use of IV or oral iron and hospitalization severity markers. Results: Among the 24,814 EPO and 2,990 DARB study patients, mean age and gender distribution at admission were similar (age: EPO 65.3 years, DARB 64.5 years; %women: EPO 53%, DARB 55%). Mean cumulative dose per inpatient stay was EPO 61,656 ± 50,274 Units and DARB 259 ± 340 mcg. RBC transfusions occurred in 37.9% of EPO patients compared to 39.8% of DARB patients (p=0.0404). Transfused EPO patients received a mean of 2.24 units versus 2.20 units for DARB patients (p=0.2111). After adjusting for covariates, the multivariate model confirmed that DARB treatment was associated with a higher risk of transfusion compared to EPO (odds ratio: 1.2, 95% CI: 1.1–1.3, p=0.0007). Conclusions: This analysis of inpatients with cancer indicates DARB treatment is associated with a higher risk of receiving RBC transfusion compared to treatment with EPO. [Table: see text]

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A phase II study of up-front red blood cell transfusion before chemotherapy followed by maintenance Erythropoetin-alpha subcutaneous support during chemotherapy of anaemic breast-, colorectal- and ovarian cancer patients

http://isrctn.org/> ◽

10.1186/isrctn81146641 ◽

2012 ◽

Author(s):

A C Ogilvie

Keyword(s):

Ovarian Cancer ◽

Blood Cell ◽

Cancer Patients ◽

Phase Ii ◽

Red Blood Cell ◽

Phase Ii Study ◽

Red Blood Cell Transfusion

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Randomised feasibility study of a more liberal haemoglobin trigger for red blood cell transfusion compared to standard practice in anaemic cancer patients treated with chemotherapy

Transfusion Medicine ◽

10.1111/tme.12439 ◽

2017 ◽

Vol 28 (3) ◽

pp. 208-215 ◽

Cited By ~ 5

Author(s):

D. Yakymenko ◽

K. B. Frandsen ◽

I. J. Christensen ◽

A. Norgaard ◽

P. I. Johansson ◽

...

Keyword(s):

Blood Cell ◽

Cancer Patients ◽

Feasibility Study ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Standard Practice

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Immune modulation and microchimerism after unmodified versus leukoreduced allogeneic red blood cell transfusion in cancer patients: results of a randomized study

Transfusion ◽

10.1111/j.1537-2995.2007.01344.x ◽

2007 ◽

Vol 47 (9) ◽

pp. 1691-1699 ◽

Cited By ~ 18

Author(s):

Valérie Lapierre ◽

Anne Aupérin ◽

Eric Robinet ◽

Christophe Ferrand ◽

Nadia Oubouzar ◽

...

Keyword(s):

Blood Cell ◽

Cancer Patients ◽

Red Blood Cell ◽

Immune Modulation ◽

Randomized Study ◽

Red Blood Cell Transfusion

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A Prospectively Randomized Placebo-Controlled Trial of Epoetin-α in Patients with Advanced-Stage Hodgkin Lymphoma: Final Analysis of the GHSG HD15-EPO Trial

Blood ◽

10.1182/blood.v112.11.2598.2598 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2598-2598 ◽

Cited By ~ 4

Author(s):

Andreas Engert ◽

Peter Borchmann ◽

Michael Fuchs ◽

Andreas Josting ◽

Heinz Haverkamp ◽

...

Keyword(s):

Blood Cell ◽

Cancer Patients ◽

Hodgkin Lymphoma ◽

Red Blood Cell ◽

Controlled Trial ◽

Red Blood Cell Transfusion ◽

Final Conclusion ◽

Advanced Stage ◽

Fatigue Score ◽

Significant Difference

Abstract Anemia is frequent among cancer patients and impacts organ function and quality of life of those affected. Anemia has been shown to be a negative prognostic factor in several malignancies including Hodgkin Lymphoma (HL). In addition, the advent of more aggressive treatment regimen such as BEACOPP escalated has resulted in more HL patients needing red-blood-cell transfusion. Thus, apart from the chemotherapy-related question of the GHSG HD15 trial, ie 8 cycles of BEACOPP escalated or 6 cycles of BEACOPP escalated or 8 cycles of BEACOPP14, patients in HD15 were randomized between Epoetin-α and placebo. Study drug was given at 40.000 I.E. weekly with a hemoglobin target level of 12–13g/dl. Primary endpoint was fatigue after the end of chemotherapy (CT) and 6 months later measured with the EORTC QLQ-C30 questionnaire (0–100 scale). With respect to the more recent safety discussion related to erythropoetins (EPOs) in general, we also analyzed efficacy and safety endpoints although the trial was not sufficiently powered for time-to-event analyses. Between1/2003 and 12/2006 1.379 patients were randomized for the EPO question of whom 1.329 were eligible. Of these 1.286 (96.8%) are fully evaluable. Patient characteristics were balanced between the placebo and the EPO arm. In those 688 patients who were randomized before 7/2005 and eligible for analysis, the CR/CRu rate was 90, 6% with a median follow-up of 28 months, 58 progressions/relapses (8.4%) and 33 deaths (4.8%) without differences between study arms. There was also no difference in terms of freedom from treatment failure (hazard ratio (HR) 0.9, 95%-confidence interval (CI) 0.6–1.4) and overall survival (HR 1.1, 95% CI 0.6–2.3). 51 serious adverse (7.4%) and 35 thrombovascular events (5.1%) were observed with no significant difference between arms. The median number of red blood cell units given significantly favored patients receiving Epoetin-α (2 vs 4; test for trend p<0.001). The interim analysis for fatigue gave an average value of 61+/−25.8 (mean +/−SD) at the end of treatment and a reduced fatigue score of 33+/−25.3 at six months after CT. Conclusion: This is the largest prospectively randomized, placebo-controlled trial with EPO in cancer patients. So far we found no difference in terms of fatigue, response, relapse, or side effects between those advanced-stage HL patients receiving Epoetin-α or placebo. The number of RBC units given was significantly reduced in the EPO group. However, all cases are needed for a final conclusion and will be presented.

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