Erythropoietin therapy in cancer-related anaemia, yes or no?

摘要

Anaemia in patients with cancer is common and has several causes, including cytokine-related inhibition of erythropoi-esis, marrow suppression from cytotoxic drugs, marrow infiltration by the neoplasm, blood loss and solid-organ toxicity associated, such as renal or hepatic impairment. Further, the anorexic cancer patient often has a poor diet.1 In this issue of the Journal, Bell et al. report on a successful open-label study of the use of epoetin alpha in cancer-related anaemia in patients undergoing chemotherapy for non-myeloid malignancies. As with previous studies, a significant positive outcome was reported with 60 % of patients achieving a very significant rise in haemoglobin. Interestingly, the rise in haemoglobin was significant at a very early phase after initiation of treatment. The authors were hoping to show that the percentage of hypochromic red cells at the onset of the study would predict responders. Unfortunately, it did not. The method for determining the percentage of hypochromic red cells is not reported in the paper. Oral iron, in a dose of elemental iron 200 mg daily, was recommended to be taken and serum ferritin of 50 ng/L was considered a good adequate iron store. Using serum ferritin as an assessment of iron stores is difficult where there may be false-positive increases due to the inflammatory effect of infectious or neoplastic disease. Also, elemental iron 200 mg daily is likely to cause significant gastrointestinal side-effects in a relatively high proportion of subjects.