Side Effects of Treatment: Anemia

What are the symptoms of anemia and how is it diagnosed and managed in cancer patients.

Anemia

Medically reviewed by C.H. Weaver M.D. Medical Editor 8/2018

Anemia is an inadequate supply of red blood cells, resulting in a decrease in the oxygen-carrying capacity of the blood. A common reason that cancer patients experience anemia is as a side effect of chemotherapy. Anemia is important because it may cause unwanted symptoms, such as fatigue, tiredness or shortness of breath, and may exacerbate or cause other medical problems, such as a heart condition. Fortunately, anemia can be effectively managed.

What is anemia

Anemia is an inadequate supply of red blood cells, resulting in a decrease in the oxygen carrying capacity of the blood. Red blood cells contain the protein hemoglobin, which carries oxygen to all parts of the body. Low levels of red blood cells, and thus hemoglobin, cause a reduction in the amount of oxygen that can be carried to the body. The decreased delivery of oxygen causes the following symptoms:

  • Fatigue or tiredness
  • Trouble breathing
  • Rapid heartbeat
  • Dizziness, light-headedness, inability to concentrate, or headache
  • Chest pain
  • Difficulty staying warm
  • Loss of sex drive
  • Pale skin

Anemia commonly occurs in cancer patients, either as a direct result of the cancer or as a side effect of cancer treatment. Chemotherapy, radiation therapy and blood loss during surgery are all common causes of anemia in cancer patients. Chemotherapy drugs kill rapidly dividing cells in the body, including cancer cells and normal cells, such as cells in the bone marrow responsible for red blood cell production. Over 60% of patients treated with chemotherapy develop anemia.[1]

Anemia occurs because patients can’t produce enough red blood cells or because red blood cells are lost through bleeding or destroyed faster than they can be produced. The production of red blood cells in the bone marrow is called erythropoiesis. Erythropoiesis is controlled by red blood cell growth factors. Erythropoietin is the major blood cell growth factor that increases red blood cell production in the bone marrow. Erythropoietin is produced by cells in the kidney. When kidney cells detect a decrease in tissue oxygen, erythropoietin is released into the circulation. The end result is increased red blood cell production in the bone marrow. Anemia can be prevented or corrected by using erythropoietin, or by giving a blood transfusion.

Many different causes of anemia exist. A careful evaluation is necessary to determine the cause of anemia so that the most appropriate treatment is administered.

Why is Anemia Important

There are three main reasons that anemia is important:

1.Patients with anemia experience unwanted symptoms such as fatigue, tiredness, shortness of breath and a reduced tolerance to activity. All of these symptoms contribute to a decreased feeling of overall well-being and treatment of anemia can alleviate these symptoms.[2],[3],[4]

2.Anemia may exacerbate or cause other medical problems. For example, anemia requires the heart to work harder and this additional stress to the heart could cause a heart attack in patients with preexisting heart disease.

3.Delivery of chemotherapy according to the planned dose and schedule of treatment is important to achieve the best treatment results. Anemia as a side effect of chemotherapy may prevent patients from receiving their treatment at the appropriate dose and time.

How is Anemia Diagnosed

A simple laboratory test known as a CBC, or complete blood count, measures the different types of cells in the blood. The results of a CBC indicate the amount of hemoglobin in the red blood cells. The hemoglobin count is the most useful indicator of anemia because it determines the oxygen-carrying capacity of the blood. The normal hemoglobin count is 12 g/dl – 16 g/dl for women and 14 g/dl – 18 g/dl for men. Patients with a hemoglobin count that falls below the normal range have anemia. In order to better understand the interpretation of a CBC, a sample is provided below.

Measurement of Blood Counts

A test called the complete blood count (CBC) is used to determine whether your red blood cells are low. The CBC measures the levels of the three basic blood cells: red, white, and platelets.

In the United States, the CBC is typically reported in the format shown below. If your blood counts fall outside of the normal range, which is shown in the “Reference interval” column, their values will be reported in the “Flag” column with an ‘L’ for low and an ‘H’ for high. The example CBC below shows that red blood cells are low.

Result: The result column shows counts that fall within the normal range.

Flag: Counts that are above or below the reference range are recorded in the flag column, and marked with an ‘L’ for low or ‘H’ for high.

Reference interval (or reference range): The reference interval shows the normal range for each measurement for the lab performing the test. Different labs may use different reference intervals.

White blood cells: White blood cells help protect individuals from infections. The above CBC report shows that the patient’s total white cell count is 7.2, which is within the normal range of 4.0-10.5.

Red blood cells: Red blood cells carry oxygen from the lungs to the rest of the body. The above CBC report indicates that the patient has a red cell count of 3.5. This count is lower than the normal range of 4.7-6.1, and is therefore recorded in the flag column and marked with an ‘L’ for low.

Hemoglobin (Hb or Hgb): Hemoglobin is a protein in the red cell that carries oxygen. The above CBC report indicates that the patient’s Hb count is 10.8, which is below the normal range of 14.0-18.0. The hematocrit (HCT) is another way of measuring the amount of Hb, and it is also low. This means that the patient has mild anemia and may be starting to notice symptoms. The reference ranges for hemoglobin and hematocrit will vary depending on age and gender. For women, they will be lower than those shown here. For example, the hemoglobin reference interval for a woman is 12.0-16.0.

Platelets: Platelets are the cells that form blood clots that stop bleeding. The above CBC report indicates that the platelet count for this patient is normal.

Differential: This portion of the CBC shows the counts for the 5 main kinds of white cells, either as percentages (the first 5 counts), or as the absolute number of cells (the second 5 counts).

Absolute neutrophil count: Neutrophils are the main white blood cell for fighting or preventing bacterial or fungal infections. In the CBC report, neutrophils may be referred to as polymorphonuclear cells (polys or PMNs) or neutrophils. The absolute neutrophil count (ANC) is a measure of the total number of neutrophils present in the blood. When the ANC is less than 1,000, the risk of infection increases. The ANC can be calculated by multiplying the total WBC by the percent of polymorphonuclear cells. For example, this patient’s ANC is 3.10, which equals the white blood cell count (7.2) times 43%.

How is Anemia Treated

Anemia can be treated by increasing the hemoglobin level with blood transfusions or with erythropoietin (epoetin alfa or darbepoetin alfa), a blood cell growth factor that increases red blood cell production. The two objectives for treating anemia are to first correct the underlying cause of the anemia and second treat the symptoms of the anemia. Successful management of anemia may require erythropoietin, transfusions or both.

Erythropoietin: Erythropoietin is a blood cell growth factor that selectively increases production of red blood cells. The body produces erythropoietin to increase red blood cell production.

Erythropoietin is FDA-approved for the treatment of anemia in patients with nonmyeloid cancers whose anemia is a result of chemotherapy. Treatment with erythropoietin causes a gradual increase in red blood cell production. The body uses iron in red blood cell production. Thus, supplemental iron may be required to adequately support erythropoietin-stimulated erythropoiesis. Virtually all patients receiving erythropoietin therapy will eventually require supplemental iron therapy.

The two commercially available forms of erythropoietin are darbepoetin alfa (Aranesp®) and epoetin alfa (Procrit®, Epogen®). Aranesp® is a longer-acting form of erythropoietin that allows patients to receive fewer injections.

Although erythropoietin has been shown to reduce the need for blood transfusions in patients with chemotherapy-induced anemia, some studies have reported serious adverse effects of erythropoietin in certain groups of patients. In response to these reports, and based on the advice of two advisory committees, the FDA released an updated Advisory on the use of erythropoietin in November 2007. Patients should discuss the risks and benefits of anemia treatment with their doctor.

More information about the FDA Advisory can be found at .

Blood Transfusion: Blood transfusions rapidly replace the oxygen-carrying capacity of the blood. The goal of a blood transfusion is to increase oxygen and carbon dioxide exchange between the tissues and reduce the symptoms of anemia. However, transfusions are associated with complications. Patients should carefully consider whether to undergo a transfusion and the benefits should outweigh the risk or complications of the procedure.

Although improvements have lowered the risk of transfusion-transmitted complications, the only way to effectively eliminate the risk is to avoid exposure to allogeneic or “banked” blood. Despite the risks, red blood cell transfusions are common treatments for the severe anemia associated with cancer and chemotherapy.

Complications of Blood Transfusion

Patients receiving red blood cell transfusions are at risk for several noninfectious reactions that range from mild allergic reactions to life-threatening anaphylaxis. Clinically, the most significant complications involve impact on the immune system. However, these conditions are rare.

Infectious Complications: Patients receiving allogeneic blood are at risk for bacterial, parasitic and viral infections. Bacterial infections are estimated to occur in 1 of every 2500 blood transfusions and viral infections occur in approximately 1 in every 3000. Fear of infection with the human immunodeficiency virus (HIV) has caused the most concern, although the risk per unit of blood transfused is relatively low (1 in 225,000 transfusions). All blood components are tested for HIV antibodies; however, there is a period of time after HIV exposure before antibodies can be detected in the blood. To address this issue, intense donor screening is being used and more sensitive tests are being developed.

Patients receiving an allogeneic transfusion are at greater risk for lethal infection with the hepatitis viruses than from HIV. It is estimated that hepatitis results from approximately 1 in every 3000 transfusions.

Other Alternatives to Allogeneic Blood Transfusions

Autologous blood transfusion: A transfusion in which the patient is used as both donor and recipient is called an autologous blood transfusion. For the patient, autologous blood transfusion has no risk of infection, alloimmunization, allergic reaction or graft-versus-host disease. Autologous blood is obtained from the recipient before it is needed, which means that collection must be preplanned (e.g., before surgery or bone marrow harvest). Usually autologous blood is not collected more than once per week and no closer than 72 hours before the procedure. The autologous blood is then mixed with an anticoagulant solution and either stored for up to 42 days or frozen.

Directed donors: Directed blood donations are collected from designated donors, usually friends and family of the recipient. However, no evidence exists that directed donor blood is safer than allogeneic blood.

Tips for Dealing with Anemia

Anemia, a common condition among cancer patients, is an inadequate supply of red blood cells that results in a decrease in the oxygen-carrying capacity of the blood. Chemotherapy, radiation therapy, and blood loss during surgery are all common causes of anemia in cancer patients. Anemia is an important consideration because it may cause unwanted symptoms, such as fatigue, tiredness, or shortness of breath and may exacerbate or cause other medical problems, such as a heart condition. Furthermore, severe anemia may cause a delay in cancer treatment. If you do experience anemia during cancer treatment, there are several steps you can take to control symptoms and lessen their impact on your treatment schedule and quality of life.

The following tips will help you handle the effects of anemia:

  1. If you experience any symptoms of anemia (such as fatigue, tiredness, or shortness of breath), tell your healthcare team immediately.
  2. Eat a well balanced diet and drink plenty of fluids.
  3. Get adequate rest.
  4. Prioritize your activities so that you can participate in those that are most important and require more energy when you are feeling your best. Low-priority activities can be put off until you feel stronger.
  5. Let friends and family help you with errands and regular chores so that you can conserve your energy.
  6. To prevent dizziness, get up slowly from a sitting position; when you are lying down, sit up slowly before standing.
  7. Consult your doctor about the risks and benefits of treatment for anemia with erythropoietin, a blood cell growth factor that increases red blood cell production. Commercially available forms of erythropoietin include epoetin alfa (Epogen® or Procrit®) and darbepoetin alfa (Aranesp®), a newer and longer acting form of erythropoietin.

Aranesp® Improves Chemotherapy-Induced Anemia Without Adversely Affecting Survival

A combined analysis of four clinical trials of Aranesp® (darbepoetin alfa) for the treatment of chemotherapy-induced anemia suggests that Aranesp reduces the need for blood transfusions, increases hemoglobin levels, and does not adversely affect survival. These results were presented at the 47thannual meeting of the American Society of Hematology.

Anemia is a common adverse effect of some chemotherapy regimens. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body.

Common symptoms of anemia are severe fatigue, shortness of breath, diminished activity levels, and a reduced overall feeling of well-being.

Severe anemia often requires treatment with blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay in cancer treatment, resulting in suboptimal chances of a cure or optimal long-term survival.

Use of medications to treat anemia has been shown to have several benefits in cancer patients, including increased quality of life and decreased need for blood transfusions. The effect on survival, however, has been uncertain. Studies have reported both positive and negative findings.

Aranesp treats chemotherapy-induced anemia by stimulating cells in the bone marrow to produce functioning red blood cells, ultimately providing sustained normal levels of red blood cells in the body. In order to evaluate the effect of Aranesp on anemia and survival, researchers in the United Kingdomcombined information from four clinical trials of Aranesp. All four trials evaluated the use of Aranesp among patients with chemotherapy-induced anemia. The combined analysis included a total of 759 subjects.

Treatment with Aranesp improved anemia and did not affect overall survival. Patients treated with Aranesp were 31% less likely to receive a blood transfusion and had significantly increased red blood cell levels.

The researchers conclude that use of Aranesp to treat chemotherapy-induced anemia reduces the need for blood transfusions, improves red blood cell counts, and is unlikely to have a negative effect on survival.

Anemia Impairs Mental and Physical Function of Elderly with Cancer

According to a recent article published in the *Annals of Oncology,*chemotherapy-induced anemia impairs both mental and physical function of elderly patients with cancer.

Anemia is a common adverse effect of some chemotherapy regimens. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body.

Common symptoms of anemia are severe fatigue, shortness of breath, diminished activity levels, and a reduced overall feeling of well-being.

Severe anemia often requires treatment with blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay in cancer treatment; this may compromise chances of a cure or optimal long-term survival.

Use of medications to treat anemia has been shown to have several benefits in cancer patients, including increased quality of life and decreased need for blood transfusions. Two common medications, Procrit® and Aranesp®, treat chemotherapy-induced anemia by stimulating cells in the bone marrow to produce functioning red blood cells and ultimately sustain normal levels of red blood cells.

Researchers from Italy recently conducted a study including 42 geriatric patients with lung cancer who were undergoing chemotherapy. Some patients were treated with Procrit, while others did not receive treatment for anemia. Anemia was measured prior to and during treatment. Comprehensive geriatric assessment variables were also measured, allowing the researchers to determine associations between anemia and cognitive/physical functioning of the patients.

  • Patients treated with Procrit had improved anemia, as well as improved cognitive and physical functioning across all measured variables.
  • Patients not treated with Procrit who developed anemia had a decrease in all measured cognitive and physical functioning variables.

The researchers concluded that the prevention or correction of anemia in elderly patients undergoing chemotherapy appears help maintain cognitive and physical functioning. This may ultimately allow for more functional independency for patients, as well as prevent mental decline. Future studies are necessary to confirm these findings and provide additional information on the treatment of anemia for elderly patients.

Aranesp® Effective for Treating Anemia Associated with “Low-Risk” MDS

According to an article published in the British Journal of Haematology, Aranesp® (darbepoetin alfa) is effective in treating anemia in patients with lower-risk myelodysplastic syndrome (MDS).

Myelodysplastic syndromes are a group of diseases involving the bone marrow. MDS results in inadequate production of red blood cells, white blood cells, and platelets. Therefore, initial treatment is often aimed at restoring levels of these cells to normal. This group of diseases ultimately leads to bone marrow failure or acute leukemia. However, some MDS patients achieve long-term survival with minimal intervention.

MDS tends to occur in elderly people who may have other significant medical problems that prevent aggressive treatment. Current treatments for MDS generally fall into the category of supportive care, particularly with agents that restore red or white blood cell levels. Patients with more advanced disease may also be treated with chemotherapy drugs.

Anemia is a common symptom among patients with MDS. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body.

Common symptoms of anemia are severe fatigue, shortness of breath, diminished activity levels, and a reduced overall feeling of well-being.

Severe anemia often requires treatment with blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay in cancer treatment, resulting in less favorable chances of a cure or optimal long-term survival.

Use of medications to treat anemia has been shown to have several benefits in cancer patients, including increased quality of life and decreased need for blood transfusions. The effect on survival, however, has been uncertain.

Aranesp treats chemotherapy-induced anemia by stimulating cells in the bone marrow to produce functioning red blood cells, ultimately providing sustained normal levels of red blood cells in the body. It is also being evaluated for the treatment of anemia that is directly caused by the cancer.

Researchers have been evaluating the schedule and dosing of Aranesp in an effort to establish the fewest number of doses that maintain effectiveness. Fewer doses require less time for the patient and physician, fewer medical resources, and reduce pain and cost.

Aranesp was previously approved at a dose of once per week. It is now the only agent approved for every three-week dosing in the management of chemotherapy-induced anemia.

Researchers from France recently conducted a clinical trial to evaluate the use of Aranesp in patients with low-risk MDS (MDS that is considered to be the least aggressive and associated with the greatest survival). This trial included 62 patients with anemia who were treated with Aranesp.

  • 71% of patients responded to treatment with Aranesp with an improvement in their anemia.
  • Of the 13 patients who had not responded to treatment with epoetin alfa, eight responded to subsequent treatment with Aranesp.
  • After a median of 40 weeks, 36 of 46 patients who responded to Aranesp continued to respond to Aranesp.

The researchers concluded that treatment with Aranesp significantly improves anemia in patients with low-risk MDS.

Review of Anemia Drugs by the FDA

The United States Food and Drug Administration (FDA) has announced that it is reviewing new data regarding erythropoiesis-stimulating agents (ESAs). ESAs are drugs used to treat anemia. They include Procrit® (epoetin alfa), Epogen® (epoetin alfa), and Aranesp® (darbepoetin alfa).

Anemia is a common side effect of chemotherapy and cancer. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body. Severe anemia often requires treatment with blood transfusions.

ESAs stimulate the body to produce more red blood cells. Use of ESAs to treat anemia caused by chemotherapy has been shown to decrease the need for blood transfusions.

ESAs are approved for the treatment of anemia in chronic kidney failure patients, in patients with cancer whose anemia is caused by chemotherapy, in patients with HIV whose anemia is caused by AZT (zidovudine), and to reduce the number of transfusions during and after major surgery (except heart surgery).

Serious adverse effects of ESAs have been reported in certain groups of patients, particularly patients who have used ESAs for indications other than for which they are approved. The FDA has recently received additional data from two clinical studies that add to a list of concerns regarding use of ESAs.

The two studies that the FDA is now reviewing include data from the PREPARE study. The first study included 733 patients with breast cancer who were treated with chemotherapy prior to undergoing surgery. A portion of patients received Aranesp, while others did not. At three years 14% of patients who had been treated with Aranesp had died compared with approximately 10% who had not received Aranesp.

The second study includes data conducted by the National Cancer Institute’s Gynecologic Oncology Group and includes patients who were being treated with chemotherapy and radiation therapy for advanced cervical cancer. Patients received either Procrit or blood transfusions for anemia. At three years 66% of patients who had not received Procrit were alive compared with 58% of patients who had not received Procrit.

It is not clear whether the ESAs were actually associated with the reduction in survival in these patients.

The FDA states that they are currently “reviewing these data and may take additional action. In the meantime, FDA recommends that health care providers review the risks and benefits of ESAs outlined in the product label and discuss this information with their patients.”

Patients who are undergoing chemotherapy may wish to speak with their healthcare provider regarding their individual risks and benefits of treatment with ESAs.

Early Treatment for Anemia Improves Quality of Life for Patients Undergoing Chemotherapy

According to an article recently published in the journal Cancer, treatment with Procrit® (epoetin alfa) for mild anemia improves quality of life and patient productivity among individuals undergoing chemotherapy.

Anemia is a common adverse effect of some chemotherapy regimens. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body.

Common symptoms of anemia are severe fatigue, shortness of breath, diminished activity levels, and a reduced overall feeling of well-being.

Severe anemia often requires treatment with blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay in cancer treatment, resulting in less favorable chances of a cure or optimal long-term survival.

Use of medications to treat anemia has been shown to have several benefits in cancer patients, including improved quality of life and decreased need for blood transfusions. Medications such as Procrit and Aranesp® (darbepoetin alfa) stimulate the body to produce more red blood cells, ultimately reducing anemia and its long-term effects. Researchers are now evaluating optimal timing of anemia treatment in various types of cancers.

Researchers from several medical institutions in the United States recently conducted a clinical trial to evaluate the use of Procrit among patients with mild anemia undergoing chemotherapy. This trial included patients with non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, chronic lymphocytic leukemia, or multiple myeloma. They were scheduled to receive four or more months of chemotherapy for their disease. Prior to treatment, all patients had normal hemoglobin levels. Patients were either treated with Procrit for mild anemia or were observed and given Procrit if their anemia became more severe.

  • Patients treated with Procrit for mild anemia spent fewer days in bed and had fewer days of restricted activity.
  • Patients treated with Procrit for mild anemia required fewer nights in the hospital, fewer clinical visits, fewer calls to physicians, and missed fewer days of work.

The researchers concluded that the use of Procrit for mild anemia, versus waiting for anemia to become more severe, significantly improves patient quality of life and patient productivity among individuals with hematologic (blood) cancers. Patients with hematologic cancers who are undergoing chemotherapy may wish to speak with their physician regarding their individual risks and benefits of early treatment for anemia.

Evidence That Aranesp® Reduces Risk of Blood Transfusions

According to a combined analysis of six clinical trials, treatment of chemotherapy-induced anemia with Aranesp® (darbepoetin alfa) reduced the likelihood of blood transfusion without adversely affecting survival or risk of cancer progression. These results were presented at the European Cancer Conference (ECCO 14).

Anemia is a common side effect of chemotherapy and cancer. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body. Anemia is often measured by levels of hemoglobin, which is a component of red blood cells. Common symptoms of anemia are severe fatigue, shortness of breath, diminished activity levels, and a reduced overall feeling of well-being.

Severe anemia often requires treatment with blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay in cancer treatment, resulting in less favorable chances of a cure or optimal long-term survival.

In cancer patients with chemotherapy-induced anemia, use of red blood cell boosters such as Aranesp has been shown to decrease the need for blood transfusions. Because of adverse health effects reported in some studies, however, the FDA advises physicians to use the lowest possible dose to avoid transfusions and to use red blood cell boosters only as indicated.

To provide additional information about the effects of Aranesp among patients with chemotherapy-induced anemia, researchers combined information from six clinical trials. These trials enrolled a total of 1,515 patients receiving multiple cycles of chemotherapy for cancers other than cancers of the white blood cells. Study participants had a baseline hemoglobin level of 11 g/dL or less.

  • As expected Aranesp reduced the need for blood transfusions.
  • Survival and risk of cancer progression were similar in patients who did and did not receive Aranesp.

These results provide additional evidence that Aranesp reduces the need for blood transfusions among cancer patients with chemotherapy-induced anemia. This analysis did not find that Aranesp had an adverse effect on survival or cancer progression.

Aranesp® Approved for Every Three-Week Dosing

The Food and Drug Administration (FDA) recently approved administration of Aranesp® (darbepoetin alfa) for every three weeks for the treatment of anemia caused by chemotherapy in patients with non-myeloid (blood) cancers. The extended time between doses provides patients and caregivers added convenience in effective management of anemia.

Anemia is a common adverse effect of some chemotherapy regimens. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body.

Common symptoms of anemia are severe fatigue, shortness of breath, diminished activity levels, and a reduced overall feeling of well-being.

Severe anemia often requires treatment with blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay in cancer treatment, resulting in less favorable chances of a cure or optimal long-term survival.

Use of medications to treat anemia has been shown to have several benefits in cancer patients, including increased quality of life and decreased need for blood transfusions. The effect on survival, however, has been uncertain. Studies have reported both positive and negative findings.

Aranesp treats chemotherapy-induced anemia by stimulating cells in the bone marrow to produce functioning red blood cells, ultimately providing sustained normal levels of red blood cells in the body. Researchers have been evaluating the schedule and dosing of Aranesp in an effort to establish the fewest number of doses that maintain effectiveness. Fewer doses require less time for the patient and physician, fewer medical resources, and reduce pain and cost.

Aranesp was previously approved at a dose of once per week. It is now the only agent approved for every three-week dosing in the management of chemotherapy-induced anemia.

Patients with chemotherapy-induced anemia may wish to speak with their physician regarding their individual risks and benefits of treatment with Aranesp.

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