Case Ashley S, Rocconi Rodney P, Kilgore Larry C, Barnes Mack N
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 618 South 19th Street, Old Hillman Building- Room 549, Birmingham, AL 35233, USA.
Gynecol Oncol. 2006 Jun;101(3):499-502. doi: 10.1016/j.ygyno.2005.11.027. Epub 2006 Jan 10.
Chemotherapy induced anemia (CIA) commonly occurs in gynecologic oncology patients. This often leads to treatment with erythropoietic stimulating agents in order to prevent chemotherapy delays, dose modifications and transfusion of red blood cells. Our objective was to determine the subsequent transfusion rates following administration of either darbepoetin alfa or epoetin alfa.
A single institution retrospective chart review was performed utilizing patients from January 2003 to September 2004 who received either darbepoetin alfa or epoetin alfa for CIA (Hgb < or = 10.0). Data collection variables included patient demographics, cancer diagnosis, chemotherapy treatment(s), laboratory data, erythropoeisis stimulation data, and transfusions. Sample size calculations were set to detect a 20% transfusion rate difference between the two groups. Chi-square, Fisher exact test and student t tests were used for statistical analysis.
123 patients were eligible for analysis (60 darbepoetin alfa; 62 epoetin alfa). 93% of darbepoetin alfa patients received 200 mg every other week, while 86% of epoetin alfa patients received 40,000 U weekly. The darbepoetin alfa and epoetin alfa groups were similar in respect to age, race, tumor type, histology, previous chemotherapy, number of chemotherapy agents, weeks of erythropoietic stimulation, and baseline serum levels of creatinine and hemoglobin. The mean baseline Hgb and change in Hgb was similar for each group (darbepoetin alfa = 11.2, 2.5 and epoetin alfa = 11.3, 2.3). Twenty one (35%) of the darbepoetin alfa patients received a transfusion of packed red blood cells compared to 12 (19%) of epoetin alfa patients (p = 0.05).
This retrospective analysis powered to detect differences in transfusion rates revealed a statistically significant difference in transfusion rates between darbepoetin alfa and epoetin alfa for the treatment of CIA. These data warrant a randomized prospective trial in gynecologic oncology patients with careful attention to the timing of initiation of treatment, dosing regimens, and titration of growth factor.
化疗所致贫血（CIA）在妇科肿瘤患者中很常见。这常常导致使用促红细胞生成素刺激剂进行治疗，以防止化疗延迟、剂量调整和红细胞输血。我们的目的是确定给予达贝泊汀α或促红细胞生成素α后的后续输血率。
对2003年1月至2004年9月期间因CIA（血红蛋白≤10.0）接受达贝泊汀α或促红细胞生成素α治疗的患者进行单机构回顾性病历审查。数据收集变量包括患者人口统计学、癌症诊断、化疗治疗、实验室数据、红细胞生成刺激数据和输血情况。样本量计算设定为检测两组之间20%的输血率差异。采用卡方检验、Fisher精确检验和学生t检验进行统计分析。
123例患者符合分析条件（60例接受达贝泊汀α；62例接受促红细胞生成素α）。93%的达贝泊汀α患者每两周接受200毫克治疗，而86%的促红细胞生成素α患者每周接受40,000单位治疗。达贝泊汀α组和促红细胞生成素α组在年龄、种族、肿瘤类型、组织学、既往化疗、化疗药物数量、红细胞生成刺激周数以及肌酐和血红蛋白的基线血清水平方面相似。每组的平均基线血红蛋白和血红蛋白变化相似（达贝泊汀α组=11.2,2.5；促红细胞生成素α组=11.3,2.3）。21例（35%）达贝泊汀α患者接受了浓缩红细胞输血，而促红细胞生成素α患者中有12例（19%）接受了输血（p = 0.05）。
这项旨在检测输血率差异的回顾性分析显示，在治疗CIA方面，达贝泊汀α和促红细胞生成素α之间的输血率存在统计学上的显著差异。这些数据值得在妇科肿瘤患者中进行一项随机前瞻性试验，同时要密切关注治疗开始时间、给药方案和生长因子的滴定。
