From the Guidelines
Recurring anemia is most commonly associated with hematologic malignancies, such as multiple myeloma, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia, as these cancers directly affect the bone marrow where blood cells are produced. These types of cancer can lead to decreased red blood cell production, resulting in anemia 1.
Key Points to Consider
- Hematologic malignancies, including leukemia, lymphoma, and multiple myeloma, are known to cause anemia due to their impact on the bone marrow 1.
- The use of erythropoiesis-stimulating agents (ESAs) in patients with anemia associated with malignancy is not recommended unless they are receiving concurrent myelosuppressive chemotherapy 1.
- Treatment of anemia in patients with nonmyeloid hematologic malignancies should begin with chemotherapy and/or corticosteroids, and ESAs should only be considered if an increase in hemoglobin is not observed after chemotherapy 1.
- Blood transfusion is also a therapeutic option for treating anemia in these patients 1.
Important Considerations
- The FDA label limits the indication for ESA use to patients receiving chemotherapy for palliative intent 1.
- Determining the treatment intent requires clinical judgment of an individual patient’s circumstances 1.
- The intended use of ESAs is to reduce red blood cell transfusion requirements 1.
From the FDA Drug Label
ESAs resulted in decreased locoregional control/progression-free survival (PFS) and/or overall survival (OS) (see Table 2) Adverse effects on PFS and/or OS were observed in studies of patients receiving chemotherapy for breast cancer (Studies 1,2, and 4), lymphoid malignancy (Study 3), and cervical cancer (Study 5); in patients with advanced head and neck cancer receiving radiation therapy (Studies 6 and 7); and in patients with non-small cell lung cancer or various malignancies who were not receiving chemotherapy or radiotherapy (Studies 8 and 9). Table 2. Randomized, Controlled Studies with Decreased Survival and/or Decreased Locoregional Control Study/Tumor/(n) Study 1 Metastatic breast cancer(n = 2098) Study 2 Metastatic breast cancer(n = 939) Study 3 Lymphoid malignancy(n = 344) Study 4 Early breast cancer(n = 733) Study 5 Cervical cancer(n = 114) Study 6 Head and neck cancer(n = 351) Study 7 Head and neck cancer(n = 522) Study 8 Non-small cell lung cancer(n = 70) Study 9 Non-myeloid malignancy(n = 989)
Reoccuring anemia is associated with several types of cancer, including:
- Breast cancer (metastatic and early) 2
- Lymphoid malignancy 2
- Cervical cancer 2
- Head and neck cancer 2
- Non-small cell lung cancer 2
- Non-myeloid malignancy 2
From the Research
Types of Cancer Associated with Reoccurring Anemia
- Hematologic malignancies, such as multiple myeloma and chronic lymphocytic leukemia, are commonly associated with anemia 3, 4
- Myelodysplastic syndromes are also characterized by anemia, which is an essential feature of the disease 4
- Other types of cancer, such as those treated with chemotherapy or radiotherapy, can also lead to anemia due to various pathogenetic mechanisms, including hypoproliferative anemia, hemolytic anemia, and uncertain etiologies 5
Pathogenesis of Anemia in Cancer Patients
- Anemia in cancer patients can be classified into four broad categories: hypoproliferative anemia, hemolytic anemia, miscellaneous etiologies, and uncertain etiologies 5
- Cancer-related anemia can be caused by the cancer itself, cancer treatment, or chemical factors produced by the cancer 6
- Anemia can also be caused by neoplastic cell infiltration into the bone marrow, hemolysis, nutritional deficiencies, and defects in erythropoiesis 3
Treatment Options for Anemia in Cancer Patients
- Erythropoietic therapy, such as epoetin alfa, can increase hemoglobin levels, reduce the need for red blood cell transfusions, and improve quality of life in patients with hematologic malignancies and anemia receiving chemotherapy 4, 7
- Blood transfusions can also be used to treat anemia, but they are associated with several adverse events and risks, and have only transient effects 4, 6