Treatment of cancer-related anemia

Badžek, Saša and Curić, Zvonimir and Krajina, Zdenko and Pleština, Stjepko and Golubić-Ćepulić, Branka and Radman, Ivo (2008) Treatment of cancer-related anemia. Collegium Antropologicum, 32 (2). pp. 615-622. ISSN 0350-6134

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Abstract

Anemia with consequent tissue hypoxia is common problem in cancer patients. Developed via various patophysiological mechanisms, it has deleterious effect on quality of life and survival of patients with cancer. Recognition of symptoms and timely initiation of treatment improve patients' quality of life, as well as efficacy of oncological treatment. Red blood cells transfusions are well known and efficient way of anemia correction. They are "golden standard" in treatment of cancer-related anemia today, and are unavoidable in almost all patients with hemoglobin concentration below 80 g/L. Newest therapy guidelines in developed countries, supported by recent literature, encourage use of recombinant human erythropoietin (rHu-EPO), although detailed meta-analyses and prospective randomized clinical trials have shown that rHu-EPO decreases the need for transfusions in only 9-45% patients with cancer, only if they have mild anemia, rHu-EPO increases incidence of thromboembolic events, and suspicion arises that it supports tumor cells growth and multiplication. Therefore, it is necessary to define subgroups of patients which are best candidates for rHu-EPO therapy, to accomplish lower intensity of transfusion therapy.

Abstract in Croatian

Anemija s posljedičnom tkivnom hipoksijom čest je problem u onkoloških bolesnika. Nastaje različitim patofiziološkim mehanizmima i ima loš učinak na kvalitetu života i preživljenje bolesnika s malignim bolestima. Prepoznavanjem simptoma i pravovremenim započinjanjem liječenja poboljšavamo kvalitetu života bolesnika, kao i učinkovitost onkološkog liječenja. Transfuzije eritrocita dobro su poznat i učinkovit način korekcije anemije. Danas predstavljaju »zlatni standard« liječenja anemije uzrokovane malignom bolešću i neizbježne su u gotovo svih bolesnika s koncentracijom hemoglobina ispod 80 g/L. Najnovije terapijske smjernice u razvijenim zemljama, sukladno novijim znanstvenim spoznajama, ohrabruju uporabu rekombinantnog humanog eritropoetina (rHu-EPO), iako su detaljnije meta-analize i prospektivna randomizirana istraživanja pokazala kako rHu-EPO smanjuje potrebu za transfuzijama u samo 9–45% onkoloških bolesnika, i to samo ukoliko imaju blagu anemiju. rHu-EPO povećava učestalost tromboembolijskih incidenata, a postavljena je i sumnja o promotivnom učinku na rast i razmnožavanje tumorskih stanica. Potrebno je jasno definirati skupine bolesnika koji su najpogodniji kandidati za liječenje s rHu-EPO, a s ciljem smanjenja intenziteta transfuzijskog liječenja.

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