Anemia is an important aspect
of cancer care because it is common, associated with symptoms such as poor quality
of life and declining physical function, and treatable.[1-5] Fatigue, a prevalent
problem in oncology patients, is also linked to anemia and is a key component
of physical function (Figure 1).[6-8]
Furthermore, recent research has revealed potentially important implications
of anemia as a variable that has impact on the efficacy of cancer therapies
including radiation therapy,[9,10] chemotherapy, and combined- modality
treatment.[12-14] While research is ongoing, it is assumed that variations in
tissue oxygenation are probably responsible, at least in part, for these findings.
The malignancy itself, or chemotherapy or other therapies can
cause decreased erythropoietin production or a reduced responsiveness in the
bone marrow to erythropoietin. The presence of an invasive malignant process
triggers an immune response with the release of various cytokines that, in turn,
interfere with bone marrow function and shorten red cell survival. These are
probably the most common causes of cancer-related anemia. Other causes include
iron and vitamin B-12 deficiencies; additional vitamin and nutritional
deficiencies; bleeding; bone marrow metastases; various types of hemolysis;
infection; renal diseases; inflammatory disorders; a variety of hematologic diseases, including hemoglobinopathies; and endocrinopathies.
During the 1960s and 1970s, blood product transfusion support
was a mainstay of therapy encouraged by the advances in transfusion medicine. In
the last 20 years, increased recognition of the potential for transmission of
viral infections, as well as a limited blood supply, brought the need for
transfusion alternatives into the forefront.
Current Therapeutic Approaches
The advent of erythropoietic therapy over the past 10 years
has allowed physicians to reduce the need for transfusions. The recognition that
anemia treatment can improve the quality of life for patients has revolutionized
the field of oncology practice.
Other than red cell transfusions and/or erythropoietin
administration, specific therapies for anemia are only helpful in a few cases.
One such new and interesting therapy is the use of the CD20 monoclonal antibody
rituximab (Rituxan) in the treatment of autoimmune hemolytic anemias, pure red
cell aplasias, and cold agglutinin disease.[16-25] Iron replacement, vitamin
B-12 replacement, and the identification of occult (usually gastrointestinal)
bleeding are also important in some patients.
Cancer and Anemia
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