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ANEMIA—USE OF ERYTHROPOIETIC AGENTS
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American Society of Hematology/American Society of Clinical Oncology (ASH/ASCO) 2010
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–Aapro M, et al. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29(suppl 4):iv96–iv110.
–ASH/ASCO guidelines update on use of epoetin and darbepoetin. Blood. 2010;116:4045-4059.
–Schrier S, Steensma D, Loprinzi L. Role of erythropoiesis-stimulating agents in the treatment of anemia in patients with cancer. Uptodate.com. 2018.
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Important facts about ESAs
Early studies raising hemoglobin level to >12 g/dL resulted in significant increased risk of venous thromboembolus.
Beware of clot risk when using ESAs with other thrombophilic drugs (tamoxifen, BCP, lenalidomide).
The molecular structure of darbepoetin increases its half-life, allowing for less frequent injections.
Fifty percent of cancers will have erythropoietin receptors on the cell surface. It has NOT been proven that ESAs’ interaction with cell surface receptors leads to cellular proliferation.
When patients stop chemotherapy for any reason, ESAs must be stopped and transfusion therapy substituted according to FDA guidelines.
The addition of intravenous iron to ESAs will increase hemoglobin more rapidly since iron is sequestered in ...