Local recurrence remains a major obstacle to achieving cure of many locally advanced solid tumors treated with definitive radiation therapy. The preventive treatment of anaemia with recombinant erythropoietin, physicians' growing awareness of transfusion risks and their interest in patients' quality of life, as well as the elaboration of new out-patient chemotherapy treatments have produced deep changes in the management of anaemia in cancer patients. The symptoms of anaemia often require specific treatment, which constitutes a therapeutic issue. It may particularly impair patients' physical and social activities. Whatever its severity, anaemia may seriously impair patients' quality of life. and may thus be a matter of etiologic diagnosis.
It may either be a result of nutritional deficiencies or derive from complications of the cancer disease or treatment. Though a slight modification of these rates is not necessarily a sign of associated disease, anaemia may sometimes reveal the existence of cancer. Rates below 13 g/dL in men and 11.5 g/dL in women are considered abnormal. Threshold rates vary with the patient's age and sex. Though only an indicator of the number of erythrocytes and of the severity of anaemia, the red blood cell count is the most frequent dosage used. Studies in a number of different cancer settings have shown that epoetin alfa significantly increases haemoglobin and haematocrit, reduces transfusion requirements and improves quality of life for the patient.Īnaemia (a deficiency of red blood cells) is a frequent complication of cancer disease. It also appears useful for the prevention of chemotherapy-induced anaemia. Studies suggest that epoetin alfa is an effective treatment in a proportion of cancer patients with symptomatic anaemia. Epoetin alfa has been widely studied for the treatment of anaemia associated with renal failure and is now recognized as having significant potential in the management of cancer-related anaemia.
Epoetin alfa is one recombinant form of erythropoietin, the primary human growth factor responsible for promoting proliferation and survival of erythroid progenitor cells. Chronic anaemia of cancer is often characterized by inappropriately low levels of endogenous erythropoietin for the degree of anaemia, and manifests clinically with generalized hypoxia and resultant severe fatigue. Anaemia is often exacerbated by cancer treatments, in particular routinely used cytotoxic chemotherapy. © 1998 by The American Society of Hematology.Ĭancer-related anaemia has a number of causes, not least the underlying malignancy itself which plays a role in suppressing erythropoiesis. Thus, in children with cancer, anemia is associated with a decreased total bone marrow erythropoietic activity which, in contrast to what has been reported in anemic cancer adults, is not related to defective EPO production. Neither leukemic nor solid tumor groups showed a significant inverse relationship between log(sTfR) and the Hb level as would be expected in anemic patients with appropriate marrow response. In all subsets of patients, sTfR levels were inappropriately low for the degree of anemia. In all patients, we found a highly significant correlation between the logarithm of EPO (log) and the hemoglobin (Hb) level. These results were compared with those obtained from appropriate control groups. Serum EPO together with sTfR levels were also determined in 60 children receiving chemotherapy (29 leukemia, 31 solid tumors). In the last 44 patients (23 leukemia and 21 solid tumors), sTfR levels were also measured.
We determined serum EPO in 111 children (55 leukemia, 56 solid tumors) at time of diagnosis. To further elucidate the pathophysiology of anemia in children with cancer, we measured serum soluble transferrin receptor (sTfR), a quantitative marker of erythropoiesis, and serum EPO at time of diagnosis and during chemotherapy in children suffering from solid tumor or leukemia.
On the basis of this defect, anemic cancer patients, both adults and children, have been treated with recombinant human EPO (rHuEPO). A defect in erythropoietin (EPO) production has been advocated as being the main cause of anemia presented at time of diagnosis or during treatment by adults with solid tumors.
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