Anaemia in cancer patients — Expert Group recommendations

Anaemia 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 anaemia 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 haemoglobin concentration and effectiveness independent of cause of anaemia. However, several adverse reactions may occur after blood component transfusion. ESAs act through stimulation of erythropoietin receptors. Use of ESA reduces the need for red blood cell transfusions, decreases the risk of post-transfusion adverse reactions, and improves quality of life of cancer patients with chemotherapy-induced anaemia. In accordance with registered indications, ESA may be administered in non-myeloidal cancer patients with chemotherapy-induced anaemia. Thromboembolic events and arterial hypertension are known risks of ESA treatment. If ESA are used in accordance with currently approved indications and are not administered when Hb concentration is 12 g/dL or above, there is no observed unfavourable effect on survival or thromboembolic risk. The goal of red blood cell transfusions in asymptomatic anaemia is maintenance of a haemoglobin concentration of 7–9 g/dL. The goal of red blood cell transfusions in symptomatic anaemia is a haemoglobin increase to the concentration needed for recovery of symptoms, but not higher than 8–10 g/dL. The goal of ESA treatment is maintenance of the lowest haemoglobin concentration needed to avoid red blood cell transfusion. ESA may be used in patients with symptomatic chemotherapy-induced anaemia and Hb concentration at 10 g/dL or below. There is no indication for ESA in patients who have Hb concentration 12 g/dL or above, or who are not receiving chemotherapy or who are receiving radiotherapy.