Chemotherapy-related anemia and early versus late epoetin alfa

Chemotherapy-related anemia is prevalent in patients with hematologic malignancies.  We conducted a randomized, open-label, multicenter trial of early vs. late epoetin alfa in this population, focusing on quality of life (QOL). Patients with non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, chronic lymphocytic leukemia, or multiple myeloma and baseline hemoglobin 10-12 g/dL scheduled for ≥4 months of myelosuppressive chemotherapy were randomized to receive 16 weeks of epoetin alfa 40,000 U once weekly immediately (early) or to wait and only receive epoetin alfa if hemoglobin decreased to <9 g/dL (late).  Those with hemoglobin >12 g/dL after three chemotherapy cycles were not randomized.  Primary endpoint was mean change in Functional Assessment of Cancer Therapy-Anemia (FACT-An) total. Two hundred sixty-nine patients with hemoglobin ≤12 g/dL were randomized.  Statistically as well as clinically significant improvements in quality of life scores were seen for patients in the early treatment group as compared to those in the late treatment group. There were also decreases in days spent in bed and days in which activities had to be restricted in the early as compared to the late treatment groups. These improvements were correlated with increases in hemoglobin levels.   Adverse events were similar between groups (fatigue most prevalent); clinically relevant thromboembolic events were more common in early patients. Treating mild anemia immediately with epoetin alfa during chemotherapy for hematologic malignancy significantly improved quality of life, productivity, and hemoglobin, as compared to delaying treatment until hemoglobin falls below 9.0 g/dL

Bibliographic reference:

Straus DJ et al.: "Quality-of-life and health benefits of early treatment of mild anemia: a randomized trial of epoetin alfa in patients receiving chemotherapy for hematologic malignancies", Cancer. 2006 Oct 15;107(8):1909-17

David J. Straus

Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA