Erythropoietin for patients with malignant disease
Abstract
Background
Anaemia associated with cancer and cancer therapy is an important clinical factor in the treatment of malignant diseases. Therapeutic alternatives are recombinant human erythropoietin (EPO) and red blood cell transfusions.
Objectives
The aim of this systematic review was to assess the effect of erythropoietin to either prevent or treat anaemia in cancer patients.
Search methods
We searched the Central Register of Controlled Trials, MEDLINE (01/1985 to 12/2001), EMBASE (01/1985 to 12/2001), other databases and reference lists of articles. We also contacted experts in the field and pharmaceutical companies.
Selection criteria
Randomised controlled trials comparing the use of recombinant human erythropoietin (plus transfusion if needed) with red blood cell transfusions alone for the treatment or prevention of anaemia in cancer patients.
Data collection and analysis
Two reviewers independently assessed trial quality and extracted data. All authors from included studies were contacted for additional information.
Main results
Twenty seven trials with 3,287 adults were included. Use of erythropoietin significantly reduced the relative risk of red blood cell transfusions (RR 0.67; 95% CI 0.62 to 0.73, 25 trials, n = 3,069). On average participants in the erythropoietin group received one unit of blood less than the control group (WMD ‐1.00; 95% CI‐1.31 to ‐0.70, 13 trials, n = 2,056). For participants with baseline haemoglobin below 10 g/dL haematological response was observed more often in participants receiving EPO (RR 3.60; 95% CI 3.07 to 4.23, 14 trials, n = 2,347). There was inconclusive evidence whether EPO improves tumour response (fixed effect RR 1.36; 95% CI 1.07 to 1.72, seven trials, n = 1,150; random effects: RR 1.21; 95% CI 0.92 to 1.59) and overall survival (adjusted data: HR 0.81; 95% CI 0.67 to 0.99; unadjusted data: HR 0.84; 95% CI 0.69 to 1.02, 19 trials, n = 2,865). There were no statistically significant adverse effects. Evidence was inconclusive with respect to quality of life and fatigue.
Authors' conclusions
There is consistent evidence that the administration of erythropoietin reduces the risk for blood transfusions and the number of units transfused in cancer patients. For patients with baseline haemoglobin below 10 g/dL there is strong evidence that erythropoietin improves haematological response. There is inconclusive evidence whether erythropoietin improves tumour response and overall survival. Research on side effects is inconclusive.
PICOs
Plain language summary
For patients with severe cancer‐related anaemia, erythropoietin reduces the proportion of patients transfused but evidence is inconclusive for quality of life and overall survival.
Historically, blood transfusion was the treatment of choice for severe cancer‐related anaemia, haemoglobin level below 8 g/dl. Human erythropoietin is a glycoprotein hormone produced in the kidney. Recombinant human erythropoietin is used to prevent and treat anaemia in cancer patients. This review showed consistent evidence that the administration of erythropoietin reduces the risk for blood transfusions and the number of units transfused in anaemic cancer patients. There is inconclusive evidence whether erythropoietin improves tumour response and overall survival. It is also unclear whether erythropoietin increases the risk of hypertension and thrombotic complications or improves quality of life and fatigue.
