Dr. G Lyman has acted as a speaker for Amgen, Inc. (Thousand Oaks, CA) and receives research support from Amgen. Dr. J Glaspy receives research support from Amgen, Inc.
Are there clinical benefits with early erythropoietic intervention for chemotherapy-induced anemia?
A systematic review
Version of Record online: 5 DEC 2005
Copyright © 2005 American Cancer Society
Volume 106, Issue 1, pages 223–233, 1 January 2006
How to Cite
Lyman, G. H. and Glaspy, J. (2006), Are there clinical benefits with early erythropoietic intervention for chemotherapy-induced anemia?. Cancer, 106: 223–233. doi: 10.1002/cncr.21570
- Issue online: 23 DEC 2005
- Version of Record online: 5 DEC 2005
- Manuscript Accepted: 16 JUL 2005
- Manuscript Revised: 24 JUN 2005
- Manuscript Received: 29 MAR 2005
- chemotherapy-induced anemia;
- early intervention;
- relative risk
In recent years there has been an increasing debate regarding the benefits of initiating erythropoietic treatment in patients with cancer when anemia is still relatively mild. To address this, a systematic review of studies was conducted that answered the following question: Is there a clinical benefit associated with early erythropoietic intervention (hemoglobin ≥ 10 g/dL) for chemotherapy-induced anemia?
A systematic review of published literature and meeting abstracts was undertaken to identify relevant studies. Data were extracted from studies meeting prespecified eligibility criteria. For outcome measures not associated with significant heterogeneity, summary measures of relative risk associated with early erythropoietic intervention were estimated using the method of Mantel and Haenszel.
Eleven studies were eligible and were included in the review. Erythropoietic treatment effectively decreased transfusion incidence and the proportion of patients with hemoglobin < 10 g/dL compared with no treatment, with relative risk reductions of 0.50 (95% confidence interval [CI], 0.43, 0.59; 7 studies, P < 0.0001) and 0.40 (95% CI, 0.19, 0.83; 4 studies, P = 0.147), respectively. The findings from both prospective studies and planned subset analyses in which early and late intervention were compared also indicated a reduction in the relative risk of both transfusions and hemoglobin < 10 g/dL after early intervention (0.55 [95% CI, 0.42, 0.73; 5 studies, P < 0.0001] and 0.44 [95% CI, 0.33, 0.57; 2 studies, P < 0.0001], respectively).
Collectively, these findings suggest that optimal clinical benefit from erythropoietic treatment of chemotherapy-induced anemia may be achieved through early intervention. Cancer 2006. © 2005 American Cancer Society.