[Treatment of anaemia in medical oncology].
Development of cytotoxic chemotherapy, which has several side effects, has resulted in the development in supportive care as well. Two families of novel drugs have spread in the care of chemotherapy induced anaemia: human recombinant erythropoietin and intravenous iron. They were praised for the decreased transfusion demand and the increased quality of life. However, if we read the literature critically, our enthusiasm should be decreased. New data show an unfavourable impact of erythropoietin on life expectancy. Furthermore, the health care policy has changed since the introduction of erythropoietin 25 years ago. Transfusion control has improved and cost awareness in health care has increased. Recommendations of the American Societies of Haematology and Clinical Oncology reflect on these considerations. Erythropoietin is not recommended in adjuvant settings. The choice between erythropoietin and transfusion is conferred to the clinician in case of the development of metastases. No sufficient scientific argument was found to support the use of intravenous iron supplementation.
Service d'Oncologie Médicale, Hôpital Saint Louis, Paris, France. kullmanndoki@hotmail.com
Tamás
T
Kullmann
Stéphane
S
Culine
D018798:Anemia, Iron-Deficiency / Q000139:chemically induced* / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006291:Health Policy / Q000639:trends; D006397:Hematinics / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D006814:Hungary; D007262:Infusions, Intravenous; D058085:Iron Compounds / Q000008:administration & dosage*; D008017:Life Expectancy; D008495:Medical Oncology; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D011788:Quality of Life; D011994:Recombinant Proteins / Q000627:therapeutic use
D006397:Hematinics; D058085:Iron Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa