Anemia spowodowana CHT - możliwości leczenia

[zosia bluszcz]

Transfuzje vs ESA u pacjentów onkologicznych leczonych CHT.


Niedokrwistość indukowana chemioterapią – skala problemu i możliwości leczenia w świetle najnowszych doniesień i rekomendacji
https://www.termedia.pl/onkologia/Niedo ... 34754.html




Erythropoietin Stimulating Agents
https://www.ncbi.nlm.nih.gov/books/NBK5 ... t=Examples




Hemoglobin decline in cancer patients receiving chemotherapy without an erythropoiesis-stimulating agent
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Chemotherapy-induced anemia can be treated with erythropoiesis-stimulating agents (ESAs), red blood cell (RBC) transfusions, or both.
According to current ESA labels, treatment with ESAs in patients receiving chemotherapy should not be considered until hemoglobin levels are less than 10 g/dL in the USA or at or below 10 g/dL in the EU [2–4]. However, ESAs take time to induce a hemoglobin response and therefore are not suitable for patients who require immediate correction of anemia [5]. Studies have suggested that initiating an ESA when hemoglobin is between 9 g/dL and 10 g/dL results in fewer transfusions compared with initiating an ESA when hemoglobin is <9 g/dL [6–8]. However, not all patients whose hemoglobin is in the 9 g/dL to 10 g/dL range will continue to fall to levels of <9 g/dL, and because ESAs have risks, the decision of when to initiate an ESA is partially informed by the rate of hemoglobin decline and the likelihood that the patient will require a transfusion if they do not receive the ESA. Few data are available regarding the proportion of patients with hemoglobin in the range of 9 g/dL to <10 g/dL who will experience a hemoglobin decline to <9 g/dL or the rate at which the decline occurs.
(…)
There are currently three options for treating chemotherapy-induced anemia in patients with advanced stage cancer who have hemoglobin levels between 9 g/dL and 10 g/dL. The first option is to wait and watch for continued hemoglobin decline and worsening of anemia symptoms. The second option, for appropriate patients, is to initiate ESA therapy. The third option is to undergo RBC transfusion. Each of these options is associated with benefits and risks. The results of this analysis suggest that for patients with hemoglobin between 9 g/dL and 10 g/dL who are planned to receive further myelosuppressive chemotherapy, the first option of waiting and watching may result in over a third of patients falling to hemoglobin <9 g/dL within 3 weeks. The RCT data further suggest that 32 % will need a transfusion within 6 weeks. Knowing that a potential hemoglobin response to ESAs takes time, waiting and watching may not be the optimal choice for patients with hemoglobin between 9 g/dL and 10 g/dL who want to minimize their risk of transfusion.

In summary, our results suggest that hemoglobin could rapidly decline when hemoglobin levels in cancer patients receiving chemotherapy drop to around 10 g/dL. This decline in hemoglobin was associated with a high rate of RBC transfusions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584249/