The impact and management of anaemia in haematological malignancies

Anaemia is a common disorder in patients with cancer, occurring in 10-40% of cases, depending upon the tumour type and chemotherapy used. It is present in nearly all patients with leukaemia at some time in the disease and in 50% of patients with lymphoma after chemotherapy. Cancer-related anaemia appears to result from a range of factors including chronic inflammation, blood loss, nutritional deficiencies, haemolysis, bone marrow infiltration by malignant cells, low serum erythropoietin (EPO) levels, and a decrease of bone marrow responsiveness to EPO. The consequences of anaemia, namely fatigue and cardiovascular symptoms, can adversely affect patients' quality of life and may even alter their response to cancer treatment. Moreover, anaemia is often associated with the presence of several adverse prognostic parameters and is also itself a predictor of poor prognosis. Furthermore, anaemia and its symptoms can be exacerbated by cancer treatment. Until recently, blood transfusions have been the mainstay of treatment for cancer-related anaemia, despite the associated risks of transfusion-related reactions and transmission of infection. By increasing haemoglobin levels and haematocrit, treatment with recombinant human erythropoietin (rHuEPO) has been shown to reduce the need for blood transfusion in patients with haematological malignancies. It is recommended that rHuEPO be administered when a patient's haemoglobin level is at risk of falling below 8g/dL, and that treatment is maintained until levels rise above 13g/dL. Consideration of the detrimental effects of anaemia on cancer patients' physical and emotional well-being and therapeutic outcome suggests that rHuEPO therapy has the potential to provide substantial clinical benefits.