title: Erythropoietin reduces anemia and transfusions after chemotherapy with paclitaxel and carboplatin.
abstract: BACKGROUND
  The authors report on anemia observed during preoperative paclitaxel and carboplatin chemotherapy in patients with advanced head and neck carcinoma and discuss how the use of recombinant human erythropoietin (r-HuEPO) ameliorates this anemia, reducing the need for subsequent packed red blood cell (PRBC) transfusions.
  
  
  METHODS
  Response to r-HuEPO was defined as reduced hemoglobin fall during preoperative chemotherapy and reduced transfusion requirements during surgery. Thirty-six patients with advanced head and neck carcinoma were evaluable after treatment with preoperative chemotherapy using paclitaxel and carboplatin. Group 1 was comprised of 14 patients who empirically received r-HuEPO at a dose of 150 U/kg 3 times per week for 3 weeks; in patients deemed nonresponders, the dose was increased to 300 U/kg and 450 U/kg in the subsequent courses. Group 2 was comprised of 22 patients who did not receive r-HuEPO.
  
  
  RESULTS
  During preoperative chemotherapy, the mean hemoglobin fall was 0.5 g/dL in Group 1 (P = 0.40). In Group 2 there was a statistically significant mean hemoglobin fall of 3.3 g/dL (P < 0.0001). There was also a nonstatistically significant trend toward fewer PRBC transfusions: none of 14 patients (0%) in Group 1 versus 4 of 22 patients (18%) in Group 2 (P = 0.141).
  
  
  CONCLUSIONS
  A significant fall in hemoglobin and an increase in the need for transfusions were observed in head and neck carcinoma patients receiving carboplatin and paclitaxel chemotherapy prior to surgery. Empiric r-HuEPO therapy appeared to prevent anemia and reduced the need for PRBC transfusions.
authors.affiliation: Saint Louis University Health Sciences Center, Department of Internal Medicine, Missouri 63110-0250, USA.
authors.forename: F R
authors.initials: FR
authors.lastname: Dunphy
authors.forename: T L
authors.initials: TL
authors.lastname: Dunleavy
authors.forename: B R
authors.initials: BR
authors.lastname: Harrison
authors.forename: J H
authors.initials: JH
authors.lastname: Boyd
authors.forename: M A
authors.initials: MA
authors.lastname: Varvares
authors.forename: C H
authors.initials: CH
authors.lastname: Dunphy
authors.forename: J J
authors.initials: JJ
authors.lastname: Rodriguez
authors.forename: E M
authors.initials: EM
authors.lastname: McDonough
authors.forename: J R
authors.initials: JR
authors.lastname: Minster
authors.forename: M D
authors.initials: MD
authors.lastname: McGrady
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced / Q000517:prevention & control*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016190:Carboplatin / Q000009:adverse effects; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000097:blood* / Q000188:drug therapy; D006441:Hemoglobin A / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D017239:Paclitaxel / Q000009:adverse effects; D011994:Recombinant Proteins
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D006441:Hemoglobin A; D016190:Carboplatin; D017239:Paclitaxel