Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update
Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update
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DOI：
10.1182/bloodadvances.2018030387
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发表时间：
2019-04-23
期刊：
影响因子：
7.5
通讯作者：
Lazo-Langner, Alejandro
中科院分区：
文献类型：
--
作者：
Bohlius, Julia;Bohlke, Kari;Lazo-Langner, Alejandro
目的：更新美国临床肿瘤学会（ASCO）/美国血液学会（ASH）关于癌症患者使用红细胞生成刺激剂（ESA）的建议。方法：检索PubMed和科克伦图书馆，查找2010年1月31日至2018年5月14日发表的癌症患者随机对照试验（RCT）和RCT荟萃分析。对于生物类似药ESA，由于癌症背景下的RCT证据有限，因此文献检索扩展至包括癌症或慢性肾脏疾病患者的荟萃分析和RCT以及癌症患者的队列研究。ASCO和ASH召开了一个专家小组审查的证据和修订以前的建议，根据需要。结果：主要的文献综述包括15个荟萃分析的随机对照试验和两个随机对照试验。越来越多的证据表明，在ESA治疗中加入铁可以改善造血反应并降低RBC输血的可能性。生物类似药文献综述表明，尽管在癌症中的证据仍然有限，但依泊苷α的生物类似药与参考产品具有相似的疗效和安全性。建议：ESA（包括生物类似药）可用于化疗相关性贫血患者，其癌症治疗目的不是治愈性的，血红蛋白下降至< 10 g/dL。RBC输血也是一种选择。除骨髓增生异常综合征患者外，大多数非化疗相关性贫血患者不应使用ESA。在ESA治疗期间，血红蛋白可能会增加到避免输血所需的最低浓度。铁替代品可用于改善血红蛋白反应，并减少接受ESA的患者的红细胞输注（无论是否缺铁）。更多信息可在www.asco.org/supportive-care-guidelines和www.hematology.org/指南上查阅。
Purpose: To update the American Society of Clinical Oncology (ASCO)/American Society of Hematology (ASH) recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.Methods: PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs in patients with cancer published from January 31, 2010, through May 14, 2018. For biosimilar ESAs, the literature search was expanded to include meta-analyses and RCTs in patients with cancer or chronic kidney disease and cohort studies in patients with cancer due to limited RCT evidence in the cancer setting. ASCO and ASH convened an Expert Panel to review the evidence and revise previous recommendations as needed.Results: The primary literature review included 15 meta-analyses of RCTs and two RCTs. A growing body of evidence suggests that adding iron to treatment with an ESA may improve hematopoietic response and reduce the likelihood of RBC transfusion. The biosimilar literature review suggested that biosimilars of epoetin alfa have similar efficacy and safety to reference products, although evidence in cancer remains limited.Recommendations: ESAs (including biosimilars) may be offered to patients with chemotherapy-associated anemia whose cancer treatment is not curative in intent and whose hemoglobin has declined to < 10 g/dL. RBC transfusion is also an option. With the exception of selected patients with myelodysplastic syndromes, ESAs should not be offered to most patients with nonchemotherapy-associated anemia. During ESA treatment, hemoglobin may be increased to the lowest concentration needed to avoid transfusions. Iron replacement may be used to improve hemoglobin response and reduce RBC transfusions for patients receiving ESA with or without iron deficiency. Additional information is available at www.asco.org/supportive-care-guidelines and www.hematology.org/ guidelines.