Use of epoetin and darbepoetin in patients with cancer: 2007 American society of clinical oncology/American society of hematology clinical practice guideline update
Use of epoetin and darbepoetin in patients with cancer: 2007 American society of clinical oncology/American society of hematology clinical practice guideline update
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DOI：
10.1200/jco.2007.14.3396
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发表时间：
2008-01-01
影响因子：
45.3
通讯作者：
Lichtin, Alan E.
中科院分区：
文献类型：
--
作者：
Rizzo, J. Douglas;Somerfield, Mark R.;Lichtin, Alan E.
目的：更新美国临床肿瘤学会/美国血液学会（ASCO/ASH）关于使用依泊苷的建议。该指南被扩展，以解决使用达贝泊胺和血栓栓塞风险与这些agents.Method更新委员会（“委员会”）审查和分析自2002年7月至2007年7月发表的数据。建议对于化疗相关性贫血患者，委员会继续建议在血红蛋白（Hb）接近或低于10 g/dL时开始使用红细胞生成刺激剂（ESA），以增加Hb并减少输血。出于类似原因，ESA治疗继续被推荐用于低风险骨髓增生异常患者。没有证据表明ESA治疗会增加生存率。缺乏结论性证据表明，在缺乏需要早期治疗的临床情况下，在Hb水平大于10 g/dL时启动ESA可以使更多患者免于输血或显著改善其生活质量。起始剂量和基于反应或缺乏反应的剂量调整应遵循包装说明书。如果根据美国食品药品监督管理局批准的标签，在无应答者中尝试适当增加剂量，则在无应答者中继续ESA超过6至8周似乎没有益处，应停止ESA治疗。委员会建议监测铁储存量，并为接受ESA治疗的患者补充铁摄入量。ESA应谨慎用于化疗，或在临床状态下，与血栓栓塞并发症的风险增加。委员会还警告说，对于没有接受化疗的癌症患者，不要使用ESA，因为最近的试验报告说，在这些情况下，血栓栓塞的风险增加，生存率降低。
Purpose To update the American Society of Clinical Oncology/American Society of Hematology (ASCO/ASH) recommendations for the use of epoetin. The guideline was expanded to address use of darbepoetin and thromboembolic risk associated with these agents.Method An Update Committee ("Committee") reviewed and analyzed data published since 2002 through July 2007. MEDLINE and the Cochrane Collaboration Library databases were searched.Recommendations For patients with chemotherapy-associated anemia, the Committee continues to recommend initiating an erythropoiesis-stimulating agent (ESA) as hemoglobin (Hb) approaches, or falls below, 10 g/dL, to increase Hb and decrease transfusions. ESA treatment continues to be recommended for patients with low-risk myelodysplasia for similar reasons. There is no evidence showing increased survival as a result of ESA treatment. Conclusive evidence is lacking that, absent clinical circumstances necessitating earlier treatment, initiating ESAs at Hb levels greater than 10 g/dL either spares more patients from transfusion or substantially improves their quality of life.Starting doses and dose modifications based on response or lack thereof should follow the package insert. Continuing ESAs beyond 6 to 8 weeks in the absence of response, assuming appropriate dose increase has been attempted in nonresponders as per US Food and Drug Administration-approved labeling, does not seem to be beneficial, and ESA therapy should be discontinued. The Committee recommends monitoring iron stores and supplementing iron intake for ESA-treated patients. ESAs should be used cautiously with chemotherapy, or in clinical states, associated with elevated risk for thromboembolic complications. The Committee also cautions against ESA use for patients with cancer who are not receiving chemotherapy, since recent trials report increased thromboembolic risks and decreased survival under these circumstances.