The use of erythropoiesis-stimulating agents in patients with non-myeloid hematological malignancies: a systematic review |
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Authors: | Nadine Shehata Irwin Walker Ralph Meyer Adam E Haynes Kevin Imrie for the Cancer Care Ontario Hematology Disease Site Group |
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Institution: | (1) Department of Medicine, St. Michael’s Hospital, University of Toronto, Canadian Blood Services, Toronto, Canada;(2) Department of Medicine, McMaster University Medical Centre, McMaster University, Hamilton, Canada;(3) National Cancer Institute of Canada Clinical Trials Group, and Department of Oncology, Queen’s University, Kingston, ON, Canada;(4) Cancer Care Ontario Program in Evidence-based Care, McMaster University, 1280 Main St W, DTC Room 317, Hamilton, ON, Canada, L8S 4L8;(5) Department of Medicine, Sunnybrook and Women’s Regional Health Care Centre, University of Toronto, Toronto, Canada; |
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Abstract: | The effectiveness of erythropoiesis-stimulating agents (ESAs) for the treatment of anemia in patients with non-myeloid hematological
malignancies needs to be assessed as the response to their administration is not uniform and their cost is high. We conducted
a systematic review (SR) of the literature to identify reports of the effect of ESAs on survival, quality of life (QOL), transfusion
requirements, and anemia. The entries to MEDLINE, EMBASE, and the Cochrane Library databases, and abstracts published in the
proceedings of the annual meetings of the American Society of Clinical Oncology and the American Society of Hematology were
searched. Seventeen reports and five abstracts of randomized trials fulfilled prospective criteria for inclusion. Five trials
reported on survival; three failed to detect differences between groups and two demonstrated inferior survival in patients
allocated to an ESA. Seven trials and three abstracts reported on QOL with four articles and three abstracts describing improvements
in patients allocated to erythropoietin. However, important methodologic limitations were identified in these reports. Seven
randomized controlled trials reported a reduction in the proportion of patients transfused. The absolute risk reduction in
transfusions ranged from 15% to 24%. This is the only SR that assesses the use of erythropoiesis-stimulating agents specifically
in patients with hematological malignancies. We conclude that available data evaluating ESAs in patients with hematologic
malignancies demonstrate that these agents reduce transfusion requirements. Limitations of these data preclude conclusions
that these agents improve QOL. More data are required to confirm the inferior survival associated with ESAs. |
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Keywords: | Erythropoietin Darbepoetin Erythropoiesis-stimulating agents ESAs Lymphoproliferative disorders Multiple myeloma Hematological malignancies |
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