Anemia in cancer patients — Expert Group recommendations. Revision 2020

Anemia is a common feature in about 40% of patients at the moment of cancer diagnosis and in more than half of patients on anticancer therapy. Therapeutic alternatives in cancer patients with anemia include substitution of lacking agents, red blood cell transfusions, and erythropoiesis-stimulating agents (ESAs). The advantages of red blood cell transfusions are rapid increase of hemoglobin concentration and effectiveness independent of the cause of anemia. However, several adverse reactions may occur after blood component transfusion. ESAs act through stimulation of erythropoietin receptors. Use of ESAs reduces the need for red blood cell transfusions, decreases the risk of post-transfusion adverse reactions, and improves the quality of life of cancer patients with chemotherapy-induced anemia. In accordance with registered indications, ESA may be administered in non-myeloid cancer patients with chemotherapy-induced anemia. Thromboembolic events and arterial hypertension are known risks of ESA treatment. If ESAs are used in accordance with currently approved indications and are not administered when hemoglobin (Hb) concentration is 12 g/dL or above, there is no observed unfavorable effect on survival or thromboembolic risk. The administration of RBC transfusions without delay is justified in patients with Hb under 7–8 g/dL and/or severe anemia-related symptoms (even at higher Hb levels) and the need for immediate Hb and symptom improvement. The goal of ESA treatment is maintenance of the lowest hemoglobin concentration needed to avoid red blood cell transfusion. ESAs may be used in patients with symptomatic chemotherapy-induced anemia and Hb concentration at 10 g/dL or below. There is no indication for ESAs in patients who are not receiving chemotherapy or who are receiving radiotherapy.