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Symptom Management and Supportive Care

Patients Previously Transfused or Treated with Epoetin Alfa at Low Baseline Hemoglobin Are at Higher Risk for Subsequent Transfusion: An Integrated Analysis of the Canadian Experience

^a Princess Margaret Hospital, Toronto, Canada; ^b London Regional Cancer Centre, London, Canada; ^c Hôtel-Dieu de Lévis, Lévis, Canada and Hôtel-Dieu de Québec, Québec City, Canada; ^d Cross Cancer Institute, Edmonton, Canada; ^e Royal Columbian Hospital, New Westminster, Canada; ^f Mount Sinai Hospital, Toronto, Canada; ^g Saint John Regional Hospital, Saint John, Canada; ^h Ortho Biotech, A Division of Janssen-Ortho, Inc., Toronto, Canada; ⁱ R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Canada; ^j DAMOS, Inc., Toronto, Canada

Key Words. Epoetin alfa • Transfusion risk predictors • Anemia management

Correspondence: Ian Quirt, M.D., Princess Margaret Hospital, Toronto, Ontario, Canada MG5 ZM9. Telephone: 416-946-2249; Fax: 416-340-3757; e-mail: ian.quirt{at}uhn.on.ca

Background. The introduction of recombinant human erythropoietin to the management of anemia in cancer patients has resulted in significant reductions in allogeneic blood transfusions, while at the same time contributing to improvements in quality of life. A recent meta-analysis of five randomized, placebo-controlled trials with patient-level data revealed that, while epoetin alfa was very effective in reducing transfusions compared with placebo, patients who were pretransfused were twice as likely to subsequently be transfused during epoetin alfa treatment.

Methods. To further assess the validity of this rather provocative concept, another integrated analysis was conducted with patient-level data from three Canadian trials, with a combined total of 665 patients receiving epoetin alfa treatments for their cancer- and chemotherapy-induced anemia.

Results. Once again, pretransfusion was the most significant baseline predictor of transfusion, with patients that were pretransfused having a significantly greater likelihood of being transfused than their transfusion-naive counterparts. Furthermore, and corroborating previous findings, baseline hemoglobin (Hb) level was again found to be a significant predictor of transfusion, with patients who were treated at a baseline Hb level < 10 g/dl having a higher chance of being transfused than patients in whom epoetin alfa was initiated at baseline Hb levels of 10–11 g/dl. In addition, when the total units transfused in patients receiving epoetin alfa at different baseline Hb levels were analyzed, >85% of the units of blood transfused were received by patients with baseline Hb levels < 10 g/dl.

Conclusion. These data strongly suggest that early treatment with epoetin alfa could significantly optimize clinical benefit in reducing the use of transfusion in cancer patients receiving chemotherapy.

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