Are there clinical benefits with early erythropoietic intervention for chemotherapy-induced anemia? A systematic review.
BACKGROUND
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 > or = 10 g/dL) for chemotherapy-induced anemia?


METHODS
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.


RESULTS
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).


CONCLUSIONS
Collectively, these findings suggest that optimal clinical benefit from erythropoietic treatment of chemotherapy-induced anemia may be achieved through early intervention.
Lyman
Gary H
GH
James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA. gary_lyman@urmc.rochester.edu
Glaspy
John
J
D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006454:Hemoglobins / Q000096:biosynthesis; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
D000970:Antineoplastic Agents; D006454:Hemoglobins; D004921:Erythropoietin