The Efficacy of rHuEPO in Cancer‐Related Anaemia

Samol, Jens; Littlewood, Timothy

doi:10.1046/j.1365-2141.2003.04129.x

Cited by 17 publications

(6 citation statements)

References 70 publications

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“…Any of these situations can give rise to erythropoiesis resistance. 1,3,4,[15][16][17] Unfortunately, no specific markers of inflammation as C-reactive protein were available for routine use at the time this study was designed.…”

Section: Discussionmentioning

confidence: 99%

Factors that condition the response to erythropoietin in patients on hemodialysis and their relation to mortality

López‐Gómez

Pórtoles

Aljama

2008

Kidney International

148

166

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The response to erythropoietin-stimulating agents (ESA) can vary among different patients and according to the different circumstances over time within a given individual. The aim of this study was to analyze the factors that can modify the response to epoetin in patients on hemodialysis (HD) and its influence on early mortality. Prospective and observational study including 1710 patients from 119 HD units in Spain with a follow-up of 12 months. To evaluate the dose-response effect of EPO therapy, we used the erythropoietin resistance index (ERI), calculated as the weekly weight-adjusted dose of EPO divided by the hemoglobin level. Patients were stratified in three groups according to ERI: group A, ERI <5; group B, ERI=5-15; group C, ERI>15 U/kg/week/g per 100 ml. Mean ERI for the entire group was 10.2+/-7.3 U/kg/week/g per 100 ml. ERI was directly related with incident comorbidity (Charlson Index), age, female gender and low body mass index with no relationship with etiology of chronic kidney disease. Patients with antecedents of heart failure, acute infection or malignant neoplasm had significantly higher ERI than those without. Transferrin saturation index, but not serum ferritin, was inversely related with ERI. Serum levels of albumin and cholesterol were related with lower ERI, but no relation was found with normalized protein catabolic rate. Patients with a permanent catheter for HD had significant higher values of ERI than those with native fistula (P=0.012). One year survival in all three groups of patients according to ERI was 0.916 in group A, 0.877 in group B and 0.788 in group C (log-rank=20.7, P<0.001). The resistance to ESA is directly related with incident comorbidity in patients on hemodialysis and it can be interpreted as a useful marker of early mortality.

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Section: Discussionmentioning

confidence: 99%

Factors that condition the response to erythropoietin in patients on hemodialysis and their relation to mortality

López‐Gómez

Pórtoles

Aljama

2008

Kidney International

148

166

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“…Unlike transfusions, the use of r-HuEPO to correct anaemia in cancer patients is associated with an intrinsic improvement in energy, activity levels and overall QOL [15,[17][18][19][20][21]. Unlike transfusions, the use of r-HuEPO to correct anaemia in cancer patients is associated with an intrinsic improvement in energy, activity levels and overall QOL [15,[17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and management of anaemia in haematologic cancer patients receiving cyclic nonplatinum chemotherapy: Results of a prospective national chart survey

Steurer

Wagner

Gastl

2004

Wien Klin Wochenschr

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“…It is also effective in avoidance of blood transfusion in cancer patients. [21][22][23] The benefit of treatment with EPO is limited in the presence of functional iron deficiency because the intense erythropoiesis stimulated by EPO causes a demand for iron greater than the ability of stores to release it. Intravenous iron is frequently needed to achieve a maximal response to EPO.…”

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confidence: 99%

Strategies for reducing the exposure to donor blood

Murphy

2005

Clinical Medicine

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Why is there a need to reduce the use of blood?The quality and safety of blood in the UK are among the best in the world but, like all other clinical procedures, the transfusion of donor blood is not risk free. The most logical approach to reducing the risk of transfusion is to use blood only when strictly clinically necessary and where there are no alternatives. There have been recent, essentially unfunded, initiatives to promote the appropriate use of blood and the avoidance of transfusion, 1,2 and the Chief Medical Officer made a number of practical recommendations in his 2003 annual report (Table 1). 3 It appears that these efforts are having some effect: the demand for blood in England and North Wales, which steadily increased during the 1990s, has successively reduced by 1%, 1% and 6% over the last three years.However, it is likely that blood usage could be further reduced without compromising patient safety.High quality evidence about clinical outcomes associated with blood transfusion has only recently been provided. Recent randomised controlled trials have shown that using less blood neither impairs nor improves patient outcome. 4,5 Current practice in surgery and critical care has been strongly influenced by one of these trials which found that a 'restrictive' transfusion strategy using a haemoglobin (Hb) concentration trigger of 7 g/dl showed a trend towards better clinical outcome than a 'liberal' strategy with an Hb trigger of 10 g/dl. 4 Data from over 24,000 patients with acute coronary syndromes demonstrated an association between transfusion and higher 30-day mortality for patients with a nadir haematocrit greater than 25%, suggesting that a haematocrit as low as 25% may be tolerated in otherwise stable patients with ischaemic heart disease. 6 The safety of blood transfusionThe risk of transfusion-transmitted infection (TTI) by donor blood transfusion has never been lower. During the period 1996-2003, data from the UK haemovigilance scheme (Serious Hazards of Transfusion (SHOT)) show that the incidence of death and major morbidity associated with transfusion was 0.39 and 1 per 100,000 units, respectively. 7 The most frequent causes of death were non-infectious complications (Table 2). Major morbidity due to TTI was mostly due to bacterial contamination associated with stored platelet concentrates. The chance that donor transfusion will transmit one of the viruses for which blood is currently tested is very low. The incidence of viral transmission of HIV, HBV and HCV is 4.58, 0.41 and 22.09 per million blood donations, respectively (K Davison; personal communication).Two of the 50 recipients of blood from blood donors known to have developed variant Creutzfeldt-Jakob disease (vCJD) have themselves become infected; one recipient died of vCJD, 8 and the other died of unrelated causes but with histological evidence of vCJD. 9 The cost of providing blood in the UK has greatly increased since 1995, mostly due to measures to reduce the risk of transmission of vCJD and to new microbiological tests. Furth...

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The Efficacy of rHuEPO in Cancer‐Related Anaemia

Cited by 17 publications

References 70 publications

Factors that condition the response to erythropoietin in patients on hemodialysis and their relation to mortality

Factors that condition the response to erythropoietin in patients on hemodialysis and their relation to mortality

Prevalence and management of anaemia in haematologic cancer patients receiving cyclic nonplatinum chemotherapy: Results of a prospective national chart survey

Strategies for reducing the exposure to donor blood

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