The American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) have updated their clinical guideline for the use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. The guideline also advises blood transfusion as a treatment option in these patients.
Some key recommendations are:
- ESAs may be offered to patients with chemotherapy-associated anemia whose cancer treatment is not curative in intent and hemoglobin (Hb) is < 10 g/dL.
- Do not offer ESAs for chemotherapy-associated anemia to patient in whom cancer treatment is curative in intent.
- ESAs should not be considered for nonchemotherapy-associated anemia except for selected patients with myelodysplastic syndromes (those with lower risk myelodysplastic syndromes and a serum erythropoietin level ≤ 500 IU/L).
- Before considering an ESA, observe the hematologic response to cancer treatment in patients with myeloma, non-Hodgkin lymphoma, or chronic lymphocytic leukemia.
- First rule out other causes of anemia or an underlying hematopoietic malignancy.
- Epoetin beta and alfa, darbepoetin and biosimilar epoetin alfa are comparable in effectiveness and safety.
- During ESA treatment, Hb may be increased to the lowest level required to avoid transfusions.
- Discontinue ESAs if no response is evident within 6 to 8 weeks and re-evaluate the patient.
- Iron replacement may be used to improve Hb response and reduce RBC transfusions for patients receiving ESA with or without iron deficiency.
(Source: Journal of Clinical Oncology. Published online April 10, 2019)