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Treating Mild Anemia Reduces Fatigue, Clinic Visits

Treating Mild Anemia Reduces Fatigue, Clinic Visits

PHILADELPHIA—Chemotherapy patients whose hemoglobin (Hb) drops below 9 g/dL
are typically treated with recombinant human erythropoietin, but those whose
anemia is in the 10 to 12 g/dL range are typically not given hematopoietic
support.

Interim data from a study presented at the 44th Annual Meeting of the
American Society of Hematology (ASH abstract 828) suggest that boosting
hemoglobin above this mild-to-moderate range not only reduces fatigue but
also reduces the number of clinic visits and the number of days of missed
work.

"Current guidelines from both ASH and the American Society of Clinical
Oncology recommend treating anemia in chemotherapy patients whose hemoglobin
drops below 10 g/dL, but state that treatment for patients whose levels are
between 10 g/dL and 12 g/dL is optional and at the discretion of the
physician. About 30% of these moderately anemic chemotherapy patients are
getting epo-etin alfa. Our question was how much this benefited patients in
terms of quality of life and cost, as well as in correction of anemia," lead
investigator David J. Straus, MD, of the Lymphoma Service, Memorial
Sloan-Kettering Cancer Center, told ONI in an interview.

The trial, sponsored by Ortho Biotech, closed on August 31, 2002, with 265
patients evaluable. Dr. Straus reported interim data on 179 patients.

This study was a randomized, open-label, multicenter, 16-week trial that
assessed the effect of once-weekly epoetin alfa (Procrit) in patients with
lymphoma, chronic lymphocytic leukemia (CLL), or multiple myeloma who were
receiving chemotherapy and who had mild-to-moderate anemia (baseline Hb 10 to
12 g/dL).

Patients were enrolled in this trial at the beginning of their
chemotherapy and randomized to epoetin alfa or observation, with the
observation group to receive epoetin alfa only if their Hb dropped below 9 g/dL.
"Patients were treated with epoetin alfa according to current guidelines if
their prechemotherapy Hb levels were between 10 g/dL and 12 g/dL, and those
with Hb levels above 12 g/dL were not eligible for randomization unless their
levels fell below 12 g/dL while on chemotherapy," Dr. Straus said.

Hemoglobin, disease status, quality of life (QOL), and health care
resource use were assessed monthly. Quality of life was measured by the
Functional Assessment of Cancer Therapy-Anemia (FACT-An) and by the Linear
Analog Scale Assessment (LASA). The Health Resource Utilization Scale was
used to estimate use of health care resources, but this has not yet been tied
to dollar estimates.

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