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a Hôtel-Dieu de Lévis, Lévis, Québec and Hôtel-Dieu de Québec, Québec City, Québec, Canada; b Cross Cancer Institute, Edmonton, Alberta, Canada; c British Columbia Cancer Agency, Vancouver, British Columbia, Canada; d Johnson & Johnson Pharmaceutical Research and Development, Raritan, New Jersey, USA; e Ortho Biotech, Division of Janssen-Ortho, Inc., Toronto, Ontario, Canada; f Princess Margaret Hospital, Toronto, Ontario, Canada
Correspondence: Ian Quirt, M.D., Princess Margaret Hospital, 610 University Avenue, 5th Floor, Room 209, Toronto, Ontario, Canada M5G 2M9. Telephone: 416-946-2252; Fax: 416-946-6546; e-mail: ian.quirt{at}uhn.on.ca
Cancer patients often receive transfusions when their hemoglobin concentration falls to dangerously low levels due to chemotherapy or due to the disease itself. The availability of recombinant human erythropoietin (rHuEPO) has significantly reduced transfusion frequencies in cancer patients. However, the predictability of transfusions prior to the use of rHuEPO for future transfusions has not been evaluated. Data from five randomized, double-blind, placebo-controlled trials in cancer patients receiving chemotherapy and epoetin alfa were utilized to calculate the relative risk of subsequent transfusions in patients who were pretransfused. A meta-analysis with patient-level data was used to assess predictors of transfusion. Baseline data from an open-label study were used to compare quality-of-life (QOL) parameters between previously transfused and transfusion-naïve patients. The mean relative risks (RR) of exposure to additional transfusion for pretransfused patients on placebo or epoetin alfa were 2.14 (95% confidence interval [CI]: 1.73, 2.65) and 2.51 (95% CI: 1.92, 3.27), respectively, compared with nontransfused patients. Data from the meta-analysis of patients on epoetin alfa showed that pretransfusion was the most significant predictor for subsequent transfusions (parameter estimate = –1.2628, p < 0.0001 from Logistic Regression Analysis). While epoetin alfa was similarly effective in reducing transfusion risks for patients with or without pretransfusions (compared with placebo), those who were pretransfused were more than twice as likely to be subsequently transfused, compared with those not pretransfused. QOL was significantly worse for pretransfused patients than for nontransfused patients, as measured by the Functional Assessment of Cancer Therapy –Anemia and the Linear Analogue Scale Assessment QOL instruments. The results suggest that transfusions prior to epoetin alfa therapy increase the risk of future transfusions, and early treatment with epoetin alfa might reduce the risk of subsequent transfusions.
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  J.-P. Spano and D. Khayat Treatment Options for Anemia, Taking Risks into Consideration: Erythropoiesis-Stimulating Agents Versus Transfusions Oncologist, May 1, 2008; 13(suppl_3): 27 - 32. [Abstract] [Full Text] [PDF]
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I. Quirt, M. Kovacs, F. Couture, A. R. Turner, M. Noble, R. Burkes, S. Dolan, R. K. Plante, C. Y. Lau, J. Chang, et al. 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 Oncologist, January 1, 2006; 11(1): 73 - 82. [Abstract] [Full Text] [PDF]
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