Rule out other causes of anemia before initiating ESAs in cancer patients

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)

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