Practical aspects of the use of erythropoiesis-stimulating agent in patients with hematological malignancy

Abstract

Anemia is one of the most common symptoms of hematological malignancy and, on the other hand, a common complication of myelosuppressive anticancer therapy. Iron, vitamin B12, folate, biological analogs of human erythropoietin (EPO), and new targeted drugs (lenalidomide, luspatercept, roxadustat, etc.) are used in clinical practice to correct anemic syndrome in cancer patients. All these activators of erythropoiesis are combined into a single group called erythropoiesis-stimulating agents (ESAs). Issues of physiological regulation of erythropoiesis, historical information on the creation of recombinant human erythropoietin (rh-EPO), structural and biological characteristics of this group of drugs are covered in this literature review. In accordance with ESMO guidelines (2018), rh-EPO is indicated for patients receiving myelosuppressive chemotherapy with symptomatic anemia with Hb < 100 g/L and asymptomatic anemia with Hb < 80 g/L. ESAs are not used in patients not receiving chemotherapy, similarly to ASCO/ASH (2019) guidelines. Iron replacement therapy in patients receiving rh-EPO should be used regardless of whether there is an initial iron deficiency or not, since its functional deficiency occurs during treatment. The low-risk MDS is exception, where rh-EPO may be the mainstay of therapy. Low-risk MDS patients with endogenous EPO levels < 500 mIU/mL and a low transfusion load of less than 2 RBCs per month are optimal candidates for rh-EPO therapy. The article is illustrated by clinical observation of a patient with R-IPSS intermediate-risk MDS treated with epoetin alfa. The problems of prevention of thromboembolic complications associated with the use of ESA are also discussed.