This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Locatelli, F. Articles by Gascón, P. PubMed PubMed Citation Articles by Locatelli, F. Articles by Gascón, P.

Is Nephrology More at Ease Than Oncology with Erythropoiesis-Stimulating Agents? Treatment Guidelines and an Update on Benefits and Risks

^aDepartment of Nephrology, Dialysis and Renal Transplant, A. Manzoni Hospital, Lecco, Italy; ^bMedical Oncology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain

Key Words. Erythropoiesis-stimulating agents • Oncology • Hematology • Nephrology • Renal disease • Transfusion • Iron

Correspondence: Pere Gascón, M.D., F.R.C.P., Division of Medical Oncology, Hospital Clinic, Institute of Hematology and Oncology, CIDIBAPS, University of Barcelona Faculty of Medicine, 08036 Barcelona, Spain. Telephone: 34-93-227-5402; Fax: 34-93-454-6520; e-mail: gascon{at}clinic.ub.es; or Francesco Locatelli, M.D., F.R.C.P., Department of Nephrology and Dialysis, A. Manzoni Hospital, Via dell'Eremo 9/11, IT-23900 Lecco, Italy. Telephone: 39-0341-489-850; Fax: 39-0341-489-860; e-mail: f.locatelli{at}ospedale.lecco.it

Received February 21, 2009; accepted for publication April 29, 2009.

Disclosures: Francesco Locatelli: Consultant/advisory role: Amgen, Roche, Affimax; Pere Gascón: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Erythropoiesis-stimulating agents (ESAs), which promote RBC production, have been extensively used to reduce transfusion requirements and improve quality of life (QoL) in both cancer patients and those with chronic kidney disease (CKD). However, the likelihood of response and duration of treatment differ in the two settings. In renal anemia, ESAs act straightforwardly as hormone-replacement therapy. The anemia of cancer, however, relates not to a lack of endogenous erythropoietin production but to diverse aspects of the disease (including a relevant inflammatory component) and chemotherapy. Response to ESAs is slower and less certain than in nephrology. In both settings, early studies showed that reversal of severe anemia was accompanied by substantial improvement in QoL. However, again in both settings, subsequent studies indicated that efforts to normalize hemoglobin might worsen outcome. In the context of cancer, this concern was reinforced by the suggestion that malignant cells had erythropoietin receptors and that its administration might therefore accelerate tumor growth, and moreover that cancer patients are more susceptible to venous thrombosis. The absence of these concerns for nephrologists, and their greater experience in managing ESAs and patients' iron status, may make them more at ease with ESAs than their counterparts in oncology. However, both groups of specialists have had to deal with reversals in recommended thresholds for intervention and restrictions imposed by regulatory authorities. In both specialties, the broad consensus now emerging is that the optimum balance of benefits and risks lies in using ESAs aimed at a hemoglobin level in the range of 11–12 g/dl, although for CKD patients there is still room for an individualized approach.

This article has been cited by other articles:

				M. Aapro An Update on Twenty Years of Anemia Management with Erythropoiesis-Stimulating Agents in Nephrology and Oncology/Hematology Oncologist, September 1, 2009; 14(suppl_1): 1 - 5. [Full Text] [PDF]