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According to results presented at the 47th annual meeting of the American Society of Hematology (ASH), chemotherapy-induced anemia in elderly patients with aggressive non-Hodgkin’s lymphoma may predict for a worse overall survival. These results strongly suggest that early intervention or prevention of chemotherapy-induced anemia with agents such as Aranesp® (darbepoetin alfa) may actually improve long-term survival in these patients.

Non-Hodgkin’s lymphoma (NHL) is cancer affecting the immune system. There are several different types of NHL, depending upon which type of immune cell has become cancerous, the aggressiveness of the cancer, and specific genetic or protein abnormalities within the cancer cell. Chemotherapy is a common treatment modality for almost all types of NHL. However, chemotherapy is associated with side effects, such as anemia. The side effects are dependent upon which chemotherapy regimen is being utilized, as well as characteristics of the patient.

Anemia is a term that refers to low levels of circulating red blood cells (RBCs) in the blood. Red blood cells are responsible for delivering oxygen to tissues throughout the entire body. Bone marrow (spongy material inside large bones) is stimulated to produce RBCs by a chemical substance called erythropoietin, which is produced by the kidneys. Each RBC contains many molecules of hemoglobin, a protein-iron complex that is responsible for the delivery of oxygen to the cells and carbon dioxide to the lungs.

Common symptoms caused by anemia include fatigue, shortness of breath, greatly diminished activity levels and a reduced overall feeling of well-being. Severe anemia often necessitates blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay or reduction in the dose of cancer treatment, which can lead to inferior treatment outcomes. Research continues to evaluate the association between anemia and patient outcomes.

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Erythropoietin can be manufactured outside the body and administered to cancer patients to treat their anemia. Recombinant human erythropoietin, or epoetin alfa, a commonly used drug for cancer patients receiving treatment, is comprised of manufactured erythropoietin. Epoetin alfa has been shown to reduce the severity of anemia and reduce symptoms of fatigue in patients receiving chemotherapy treatment by stimulating the bone marrow to produce more RBCs. Currently, Aranesp® (darbepoetin alfa) and epoetin alfa (Procrit®) are two forms of manufactured erythropoietin most often utilized for the treatment of anemia in the United States. Aranesp®, which requires less frequent dosing than epoetin alfa, has been approved by the FDA for the treatment of anemia caused by chemotherapy in non-myeloid cancers, or cancers that do not originate in blood cells. Less frequent dosing results in fewer injections and fewer office visits for patients, reducing the need for patients and caregivers to take time off from work or leisure. The use of Aranesp® is gaining momentum in the clinical setting as results from clinical trials continue to indicate its effectiveness in comparison to epoetin alfa.

Researchers from Italy recently analyzed data evaluating several variables, including anemia, and their relation to outcomes in elderly patients with aggressive non-Hodgkin’s lymphoma. The data included 168 patients from 5 different medical institutions in Italy who were treated between 1993 and 2001 with a conventional chemotherapy regimen referred to as VNCOP-B. According to the data, the occurrence of anemia following treatment with chemotherapy was associated with reduced overall survival in these patients. In addition to anemia, more advanced cancer, as well as detectable cancer following chemotherapy also predicted for a worse overall survival.

The researchers concluded that the occurrence of chemotherapy-induced anemia appears to predict for a worse overall survival in elderly patients with aggressive NHL. These data suggest that early intervention or prevention of anemia with agents such as Aranesp® in this patient population may ultimately improve overall outcomes, including long-term survival. Further studies are necessary to confirm this finding and to determine which patients are optimal candidates for anemia prevention. Elderly patients with NHL undergoing chemotherapy or those who have chemotherapy-induced anemia may wish to speak with their physician regarding their individual risks and benefits of utilizing Aranesp® in the management of their anemia.

Reference: Zinzani P, Tani M, Molinari A, et al. Role of Anemia in Survival of Elderly Aggressive Non-Hodgkin’s Lymphoma Patients Following Chemotherapy. Proceedings from the 47th annual meeting of the American Society of Hematology (ASH). December 2004. Abstract #3315.

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