Birgegård Gunnar, Gascón Pere, Ludwig Heinz
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Eur J Haematol. 2006 Nov;77(5):378-86. doi: 10.1111/j.1600-0609.2006.00739.x.
Until recently, no prospective epidemiologic survey of lymphoma and multiple myeloma (L/MM) in European cancer patients had been conducted; furthermore, data on prevalence, incidence, and treatment patterns of L/MM were limited or unavailable. Here we define anemia prevalence, incidence, and treatment patterns, and identify anemia risk factors in European L/MM patients.
Data for a subgroup of 2360 L/MM patients in the European Cancer Anaemia Survey (ECAS) were analyzed; variables included age, gender, tumor type/stage, cancer and anemia treatment, WHO performance status, and hemoglobin (Hb) levels.
2316 patients were evaluable (1612 L and 704 MM). Anemia rate at enrollment was 52.5%. At enrollment, Hb levels correlated significantly with WHO scores (r = -0.306, P < 0.001). Anemia prevalence during ECAS was 72.9% (MM, 85.3%; non-Hodgkin's lymphoma, 77.9%; Hodgkin's disease, 57.4%); incidence in chemotherapy patients was 55.4%. Only 47.3% of patients anemic any time during ECAS received anemia treatment; overall Hb nadir for initiating treatment was 8.9 g/dL (epoetin, 9.5 g/dL; transfusion, 8.2 g/dL). Factors found to significantly (P < 0.03) increase anemia risk were low initial Hb, female gender, persistent/resistant disease, and platinum chemotherapy.
L/MM patients have a high prevalence and incidence of anemia; however, anemia is not optimally treated. Anemia is common in L/MM patients and, given its known adverse impact on physical functioning and quality-of-life variables including fatigue and cognitive function, anemia management should be an integral part of their care. Predictive factors identified by ECAS may help clinicians develop optimal anemia treatment strategies for L/MM patients.
直到最近，欧洲癌症患者中尚未进行过关于淋巴瘤和多发性骨髓瘤（L/MM）的前瞻性流行病学调查；此外，关于L/MM的患病率、发病率和治疗模式的数据有限或无法获取。在此，我们确定欧洲L/MM患者的贫血患病率、发病率和治疗模式，并识别贫血的危险因素。
分析了欧洲癌症贫血调查（ECAS）中2360例L/MM患者亚组的数据；变量包括年龄、性别、肿瘤类型/分期、癌症和贫血治疗、世界卫生组织（WHO）体能状态以及血红蛋白（Hb）水平。
2316例患者可进行评估（1612例淋巴瘤患者和704例多发性骨髓瘤患者）。入组时贫血率为52.5%。入组时，Hb水平与WHO评分显著相关（r = -0.306，P < 0.001）。ECAS期间贫血患病率为72.9%（多发性骨髓瘤患者为85.3%；非霍奇金淋巴瘤患者为77.9%；霍奇金病患者为57.4%）；化疗患者中的发病率为55.4%。在ECAS期间任何时候贫血的患者中，仅47.3%接受了贫血治疗；开始治疗时的总体Hb最低点为8.9 g/dL（促红细胞生成素治疗时为9.5 g/dL；输血时为8.2 g/dL）。发现显著（P < 0.03）增加贫血风险的因素为初始Hb水平低、女性性别、持续性/难治性疾病以及铂类化疗。
L/MM患者贫血的患病率和发病率较高；然而，贫血未得到最佳治疗。贫血在L/MM患者中很常见，鉴于其对包括疲劳和认知功能在内的身体功能和生活质量变量已知的不利影响，贫血管理应成为其治疗的一个组成部分。ECAS确定的预测因素可能有助于临床医生为L/MM患者制定最佳贫血治疗策略。
