[MOL] Series [01123] Medicine On Line

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What About Anemia in Patients With Solid Tumors?

While the focus of the previous discussion was on the anemia patient with hematologic malignancies, previous phase II trials, the initial pivotal US placebo-controlled trial, a randomized phase III trial, and 3 large, community-based clinical trials -- totaling more than 7000 patients -- included a majority of patients with solid tumors.[11] Relying on all the information acquired, Dr. Soignet proposed a paradigm shift in the concept of which level of hemoglobin is worthy of consideration for management. According to the physiologic principles that were used in development of many transfusion policies in the 1980s, a "physiologic hemoglobin of importance" was 8 g/dL. However, as more data on the quality of life are becoming available, a "functional" level of hemoglobin that appears to be important is 12 g/dL, as it may be favorably associated with significant improvements in fatigue, compared with lower hemoglobin levels. This conclusion would be in keeping with the body's normal endogenous erythropoietin response outlined previously in Figure 2. So cancer-related anemia acquires a much broader level of importance in the management of cancer patients, as it may contribute to the comorbidity of the illness, by potentially compromising tolerability and efficacy of therapy, reducing the ability to perform normal daily activities and impairing overall quality of life.

The prevalence of anemia in patients with solid tumors is related again to the anemia of chronic diseases as well as to treatments. In a survey of patients receiving cytotoxic chemotherapy, 50% to 60% of patients with lymphomas, lung cancer, gynecologic tumors, and genitourinary tumors required red blood cell transfusion support during chemotherapy.[17] Of the more than 12 million units of blood transfused annually in the United States, approximately 1 million were administered to anemic cancer patients. Generally these transfusions have been done to support the physiologic level of a hemoglobin level of 8 g/dL rather than the functional level of 12 g/dL. Due to limited supply and safety concerns, transfusion of cancer patients to maintain a hemoglobin level of at least 12 g/dL is simply not a viable option in the day-to-day management.

Warmly, lillian
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