title: Erythropoiesis-stimulating agents in the management of cancer patients with anemia: a meta-analysis.
abstract: BACKGROUND
  Erythropoiesis-stimulating agents (ESAs) are widely used in the management of anemia in cancer patients. Despite their apparent effectiveness, recent studies have suggested that ESAs could result in serious adverse events and even higher mortality. The aim of the current study was to evaluate the benefits and risks of ESAs in the management of cancer patients with anemia using a meta-analysis.
  
  
  METHODS
  The initial literature search covered Medline, PubMed, Embase, and the Cochrane Center Register of Controlled Trials, and identified 1,569 articles. The final meta-analysis included eight randomized controlled trials (n=2,387) in cancer patients with <11 g/dL hemoglobin (Hb) at the baseline and target Hb (for stopping ESA treatment) at no more than 13 g/dL. The assessment measures included Hb response, blood transfusion rate and adverse events that included venous thromboemblism (VTE), hypertension, and on-study mortality. The results are expressed as pooled odds ratio (OR). Publication bias was assessed using funnel plot analysis.
  
  
  RESULTS
  ESAs significantly increased the Hb concentration [OR 7.85, 95% confidence interval (CI): 5.85 to 10.53, P<0.001] and reduced the red blood cell (RBC) transfusion rate (OR 0.52, 95% CI: 0.42 to 0.65, P<0.001). ESAs did not increase the accumulated adverse events (OR 0.95, P=0.82), or the on-study mortality (OR 1.09, P=0.47).
  
  
  CONCLUSIONS
  ESAs are not associated with increased frequency of severe adverse events in anemic cancer patients when the target Hb value is no more than 13 g/dL.
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Li
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yan
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Dexiao
authors.initials: D
authors.lastname: Kong
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Zou
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Jihua
authors.initials: J
authors.lastname: Wang
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Dianshui
authors.initials: D
authors.lastname: Sun
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
authors.forename: Chengyun
authors.initials: C
authors.lastname: Zheng
keywords: Adverse events; anemia; cancer; erythropoiesis-stimulating agents (ESAs)