The ASH/ASCO clinical guidelines on the use of erythropoietin

The only combined effort between the American Society of Hematology (ASH) and the American Society of Clinical Oncology (ASCO) in practice guideline development was in studying the use of erythropoietin in chemotherapy-related anemia and in myelodysplasia. This process began with an application to the Agency for Health Care Policy and Research (AHCPR, now called the Agency for Healthcare Research and Quality, or AHRQ) jointly from ASH and ASCO. As part of a competitive review process, the topic was selected by the Agency for funding. Subsequently, as part of the Agency's Evidence-based Practice program, funding to conduct the review was awarded to the Evidence-based Practice Center of the Blue Cross/Blue Shield Technology Evaluation Center, which performed an extensive literature review using principals of evidence-based medicine and with input from representatives of ASH and ASCO. That evidence-based review was then shared with an ASH and ASCO guidelines committee funded by both organizations and made up of members from both organizations. The guideline was developed over a period of 21/2 years, culminating in simultaneous publication in both Blood and The Journal of Clinical Oncology in October 2002. This field is in flux and much of the guideline discussed potential future directions for research. Projected research topics include whether a hemoglobin level of 11g/dl as a clinical trigger point has clinical benefit; whether increasing hemoglobin levels greater than 12g/dL has clinical benefit; what role iron supplementation plays in erythropoietin treated patients; weekly versus more frequent dosing; and cost benefit analyses. Quality of life considerations are important, but the practice guideline committee felt that there was not enough data in this area to view it with the same importance as avoidance of transfusion or rises in hemoglobin value as therapeutic goals for patients being treated with erythropoietin.