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Cancer: Erythropoietin may reduce blood transfusions

Erythropoietin treatment for anemia may reduce the risk for blood transfusions and improve hematologic response in cancer patients, but evidence that the treatment affects survival is inconclusive.

Anemia is a common complication among cancer patients. Not only can it cause physical symptoms and diminish a patient's quality of life, but anemia may also result in a poorer response to radiotherapy or chemotherapy due to increased tumor hypoxia.

To determine the association between Erythropoietin treatment and hematologic response, blood transfusions, adverse events, and overall survival, Andreas Engert, from University of Cologne in Germany, and colleagues conducted a meta-analysis of 27 randomized, controlled trials published between 1993 and 2002.

The trials had compared Erythropoietin treatment versus no treatment in a total of 3,287 adult cancer patients.

The likelihood of needing a blood transfusion was lower in patients who received Erythropoietin treatment than in those who did not.

Erythropoietin-treated patients with very low baseline hemoglobin levels were more likely to have a hematologic response than untreated patients.
The risk for thromboembolic events was similar in both groups.

The researchers also found suggestive but inconclusive evidence that Erythropoietin may improve overall survival. However, this contrasts with the results of two recently published randomized controlled trials, which were not included in this analysis, in which patients treated with Erythropoietin had worse survival than untreated patients.

According to authors, Erythropoietin should not be used to increase overall survival outside clinical trials.

Erythropoietin may be used routinely to increase hemoglobin levels and to reduce the need for transfusion in patients with falling hemoglobin levels approaching 10 g/dL.

Adverse events such as thromboembolic complications and hypertension should be monitored.

Source: Journal of National Cancer Institute, 2005