Medical College of Wisconsin, Milwaukee, WI, USA.
J Clin Oncol. 2010 Nov 20;28(33):4996-5010. doi: 10.1200/JCO.2010.29.2201. Epub 2010 Oct 25.
To update American Society of Clinical Oncology/American Society of Hematology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.
An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched.
The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews.
For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels ≥ 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration-approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations.
更新美国临床肿瘤学会/美国血液学会关于癌症患者使用红细胞生成刺激剂（ESAs）的建议。
更新委员会审查了 2007 年 1 月至 2010 年 1 月期间发表的数据。检索了 MEDLINE 和 Cochrane 图书馆。
文献检索结果为一项新的个体患者数据分析和四项基于文献的荟萃分析、两项系统评价以及 13 项报告了未包含在之前或新的综述中的随机对照试验新结果的出版物。
对于正在接受骨髓抑制性化疗且血红蛋白（Hb）水平低于 10 g/dL 的患者，更新委员会建议临床医生讨论 ESAs 的潜在危害（例如血栓栓塞、生存时间缩短）和益处（例如减少输血），并将这些与 RBC 输血的潜在危害（例如严重感染、免疫介导的不良反应）和益处（例如 Hb 快速改善）进行比较。对假定风险的个人偏好应有助于管理化疗引起的贫血的共同决策。委员会告诫在其他情况下不要使用 ESA。如果使用，应尽可能低剂量使用 ESA，并将 Hb 增加到尽可能低的浓度以避免输血。现有证据并未确定 Hb 水平≥10 g/dL 是开始治疗的阈值或 ESA 治疗的目标。根据美国食品和药物管理局批准的标签，应在反应或无反应后开始剂量和剂量调整。无反应者应在 6 至 8 周后停止使用 ESA。除了低风险骨髓增生异常综合征患者外，不建议在未接受同期化疗的癌症患者中使用 ESA。在与血栓栓塞并发症风险增加相关的疾病中使用 ESA 与化疗药物时应谨慎。表 1 列出了详细的建议。
