Treatment of Anemia with Erythropoietic Agents in Patients with Hematologic Malignancies

Anemia is common in patients with hematologic malignancies, occurring in up to 70% of patients; it is associated with debilitating fatigue and weakness that negatively affect the ability of patients to conduct daily activities and cope with cancer. The severity of anemia in this population is dependent on the specific malignancy diagnosed, extent of disease, and the type and duration of chemotherapy received. Despite the well-known adverse consequences of anemia in patients with cancer, nearly half of patients with hematologic malignancies do not receive treatment for anemia. Clinical trials have demonstrated that treatment with erythropoietic agents (ie, epoetin alfa, epoetin beta, and darbepoetin alfa) in anemic patients with hematologic malignancies significantly increases hemoglobin (Hb) and reduces transfusion requirements. In addition, there is growing evidence to support the role of these agents in alleviating anemia-related symptoms and improving quality of life (QOL). Clinical practice guidelines issued by the National Comprehensive Cancer Network recommend erythropoietic therapy for patients receiving chemotherapy who have a Hb level ≤ 11 g/dL and symptoms or risk factors related to anemia. However, several trials of epoetin alfa therapy in patients with solid tumors or hematologic malignancies and mild-to-moderate anemia (Hb levels ≥ 8 g/dL to ≤ 12 g/dL) receiving chemotherapy have demonstrated a positive effect on hematologic and QOL outcomes. Final results from a recent clinical trial evaluating the effects of earlier treatment with epoetin alfa on hematologic outcomes, QOL, health care resource utilization, and work/productivity in patients with mild anemia will provide further information on the most appropriate strategy for anemia treatment in this population.