title: Hemoglobin decline in cancer patients receiving chemotherapy without an erythropoiesis-stimulating agent.
abstract: OBJECTIVE
  The aim of this study was to examine the rate and timing of hemoglobin decline from <10 g/dL to <9 g/dL in cancer patients receiving chemotherapy.
  
  
  METHODS
  Pooled data from the placebo arms of six randomized, controlled trials (RCTs) of darbepoetin alfa and data from an aggregated US community oncology clinic electronic medical records (EMR) database were analyzed. Patients had baseline hemoglobin ≥10 g/dL (RCTs) or baseline hemoglobin between ≥10 g/dL and <11 g/dL (EMR episodes) that declined to <10 g/dL at least once during the study period. The proportion of patients/episodes with hemoglobin decline to <9 g/dL by 3, 6, and 9 weeks without erythropoiesis-stimulating agents was estimated from data in each of the data sources, as was the rate of transfusions in the RCTs.
  
  
  RESULTS
  Data from 411 patients receiving placebo in the RCTs and 10,523 patients (10,942 episodes) in the EMR database were analyzed. Forty percent and 35 % of RCT patients and EMR episodes, respectively, had a hemoglobin decline from <10 g/dL to <9 g/dL at week 3, 54 % and 43 % at week 6, and 58 % and 46 % at week 9. Of patients in the RCTs, 43 % required an RBC transfusion.
  
  
  CONCLUSIONS
  Hemoglobin can rapidly decline in cancer patients receiving chemotherapy with hemoglobin levels around 10 g/dL, particularly in patients ≥65 years of age. The rapid rate of hemoglobin decline in these patients should be considered for optimal anemia management.
authors.affiliation: Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. robert.pirker@meduniwien.ac.at
authors.forename: Robert
authors.initials: R
authors.lastname: Pirker
authors.forename: Melissa
authors.initials: M
authors.lastname: Pirolli
authors.forename: Jane
authors.initials: J
authors.lastname: Quigley
authors.forename: Scott
authors.initials: S
authors.lastname: Hulnick
authors.forename: Jason
authors.initials: J
authors.lastname: Legg
authors.forename: Helen
authors.initials: H
authors.lastname: Collins
authors.forename: Johan
authors.initials: J
authors.lastname: Vansteenkiste
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000139:chemically induced*; D016001:Confidence Intervals; D000068256:Darbepoetin alfa; D016208:Databases, Factual; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000031:analogs & derivatives* / Q000494:pharmacology; D005260:Female; D006397:Hematinics / Q000494:pharmacology*; D006441:Hemoglobin A / Q000172:deficiency*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014481:United States
chemical_list: D006397:Hematinics; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D006441:Hemoglobin A