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Management of Anemia in cancer patients

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Anemia in cancer patients are important both in terms of quality of life as well as response to therapy. Cause of anemia is multi-factorial and its management is critical in optimizing best outcomes of cancer patients

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Management of Anemia in cancer patients

  1. 1. Management of anemia in cancer patients Dr. Ayushi Patni Moderator: Dr Ajeet Kumar Gandhi Dr RMLIMS, Lucknow
  2. 2. Anaemia= Hb<10gm/dl Investigations:- • CBC,KFT,LFT • Iron profile {transferrin saturation(TSAT) and serum ferritin(SF)} • Folate and Vitamin B12 levels • CRP • Drug history • Peripheral blood examination/bone marrow examination • Reticulocyte count, Occult blood loss and renal insufficiency • Coomb`s testing: CLL, NHL, AIH • Endogenous erythropoietin levels in MDS patients When will we treat anaemia? • If Hb<10gm/dl and pt is symptomatic • If Hb<8gm/dl even if asymptomatic • If we want to give further chemotherapy or radiotherapy
  3. 3. • Treatment options:- – Nutritional supplementation • IV iron • Vit B12 • Folic acid – Erythropoiesis stimulating agents (ESA) – RBC transfusions – Treatment of the underlying cause eg. Cancer, bleeding, etc.
  4. 4. TSAT <20% + SF <100ng/ml Absolute Iron Deficiency IV iron Ferric carboxy maltose: Max. infusion dose-20mg/kg body weight(1000mg iron per week) Min. infusion time-15 min Add ESA if Hb<10gm/dl TAST <20% + SF-normal Functional Iron Deficiency ESA + IV Iron before or during ESA therapy No Iron Deficiency ESA Darbepoetin alpha: 6.75mcg/kg body wt. every 3 weeks or 2.25mcg/kg body wt. every week If on follow up iron deficiency then add IV Iron If Hb <7-8gm/dl or severe anaemia related symptoms or rapid increase in Hb required- RBC transfusion
  5. 5. Erythropoiesis Stimulating Agents • Indications (ASCO/ASH Guideline):- – symptomatic anaemia who receive chemotherapy or combined CTRT with Hb level <10 g/dL – patients with asymptomatic anaemia who receive chemotherapy with Hb level <8 g/dL • Hb target level : 10-12gm/dl (rise of>2g/dL over a 4wk period should be avoided) • ESA dose escalations and changes from one ESA to another in patients not responding within 4–8 weeks are not recommended. In these patients ESA therapy should be stopped. • Side effects- venous thromboembolism(VTE). Increased risk in high haematocrit, older age, prolonged immobilisation, malignant disease, major surgery, multiple trauma, a previous VTE, chronic heart failure, tumour types (e.g. pancreatic cancer) and treatment regimens (e.g. Lenalidomide, thalidomide, etc.)
  6. 6. Erythropoiesis Stimulating Agents ESAs should be stopped: • Desired Hb Concentration is achieved • No response to ESAs therapy after 8 weeks of therapy • Chemotherapy course is completed ESAs should NOT be used for patients with cancer and anaemia not associated with chemotherapy. Weigh the risks of thromboembolism in patients who are being considered for ESAs Identify alternative causes of anaemia aside from chemotherapy or the underlying malignancy Some guidelines suggest not to use ESAs when intent of treatment is cure Epoetin alfa: • 100-150 units/kg sc three times weekly along with supplemental iron • 40,000 U weekly or 80,000 U every 2 weekly can also be given Darbepoetin alfa: • 2.25 micrograms/kg SC weekly or 500 mcg every 3 weeks • 200 mcg every 2 weeks
  7. 7. • Indications of IV iron- – patients on chemotherapy with Hb 11 g/dL or Hb decrease >2 g/dL from a baseline level of 12 g/dL) and absolute ID. – If ESA treatment is considered, iron treatment should be given before the initiation of and/or during ESA therapy in functional ID – Feeric carboxymaltose/ferumoxytol has less chances of anaphylactic reactions – Oral iron may be given and IV reserved for TS :20-50%; Ferritin 30-800 ng/ml
  • janakidhashanan

    Jan. 22, 2021
  • MeghaPrem

    Apr. 18, 2020

Anemia in cancer patients are important both in terms of quality of life as well as response to therapy. Cause of anemia is multi-factorial and its management is critical in optimizing best outcomes of cancer patients

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