The American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) have updated their clinical guideline for the use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. The guideline also advises blood transfusion as a treatment option in these patients.

Some key recommendations are:

• ESAs may be offered to patients with chemotherapy-associated anemia whose cancer treatment is not curative in intent and hemoglobin (Hb) is < 10 g/dL.
• Do not offer ESAs for chemotherapy-associated anemia to patient in whom cancer treatment is curative in intent.
• ESAs should not be considered for nonchemotherapy-associated anemia except for selected patients with myelodysplastic syndromes (those with lower risk myelodysplastic syndromes and a serum erythropoietin level ≤ 500 IU/L).
• Before considering an ESA, observe the hematologic response to cancer treatment in patients with myeloma, non-Hodgkin lymphoma, or chronic lymphocytic leukemia.
• First rule out other causes of anemia or an underlying hematopoietic malignancy. 
• Epoetin beta and alfa, darbepoetin and biosimilar epoetin alfa are comparable in effectiveness and safety.
• During ESA treatment, Hb may be increased to the lowest level required to avoid transfusions.
• Discontinue ESAs if no response is evident within 6 to 8 weeks and re-evaluate the patient.
• Iron replacement may be used to improve Hb response and reduce RBC transfusions for patients receiving ESA with or without iron deficiency.

(Source: Journal of Clinical Oncology. Published online April 10, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA