Anemia factor guidelines – pro

Lay Summary: Procrit and Aranesp are being heavily regulated based on the guidelines presented here.

In order to provide a framework for erythropoietin therapy, several evidence-based guidelines have been developed, differing in scope and methodological rigor. Evaluation of iron stores is essential to proper application of these guidelines. In iron deficiency, erythropoietic factors are presumed not to be effective and the guidelines aim to avoid adminsitration of Aranesp or Procrit without prior or concommitant iron therapy in such cases. The most authoritative guideline to date was developed by the American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH), as well as NCCN. Guidance on the use of darbepoetin alfa was given in the more-recently published guidelines of the European Organization for Research and Treatment of Cancer (EORTC), the National Comprehensive Cancer Network and Cancer Care Ontario. To summarize, erythropoietin or darbepoietin may be used routinely outside of clinical trials to increase Hb levels and to reduce the need for transfusion in patients with Hb levels of less than 10 g/dl and in patients with falling Hb levels approaching 10 g/dl and kept between 1o and 112, but not above 11.

There are required parameters to exclude coexisting iron deficiency which center on iron saturation above 20%. Ferritin alone can be misleading in cancer patients since it is an acute phase reactant. Iron saturation tends to rise rather than a decrease in cancer patients.

Procrit, Prescribing Information 2018

Rizzo JD, Brouwers M, Hurley P, Seidenfeld J, Arcasoy MO, Spivak JL, Bennett CL, Bohlius J, Evanchuk D, Goode MJ, Jakubowski AA, Regan DH, Somerfield MR.
American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer.
Blood. 2010 Oct 25.

J. Seidenfeld, M. Piper, C. Flamm, V. Hasselblad, J. O. Armitage, C. L. Bennett, M. S. Gordon, A. E. Lichtin, J. L. Wade III, S. Woolf, and N. Aronson Epoetin Treatment of Anemia Associated With Cancer Therapy: a Systematic Review and Meta-analysis of Controlled Clinical Trials J Natl Cancer Inst, August 15, 2001; 93(16): 1204 – 1214

Rizzo JD et al. (2002) Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. J Clin Oncol 20: 4083-4107

Bokemeyer C et al. (2004) EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer. Eur J Cancer 40: 2201-2216, 2012

Steinbrook R. Medicare and erythropoietin. N Engl J Med. 2007; 356:4-6.

Ellervik C, Tybjaerg-Hansen A, Nordestgaard BG. Risk of cancer by transferrin saturation levels and haemochromatosis genotype: population-based study and meta-analysis. J Intern Med. 2012 Jan;271(1):51-63.

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