Interventions for anemia in pediatric cancer patients

BACKGROUND: Children with cancer frequently develop anemia both from the disease and from chemo- and radiotherapy. Considered a manageable complication, anemia is often not treated until it becomes severe, i.e., hemoglobin (Hb) level <or= 7 g/dL. The most frequent treatment employed for anemia in children with cancer is blood transfusion. PROCEDURE AND RESULTS: A retrospective survey of 74 children demonstrated that the use of blood transfusions increased as the intensity of therapy increased. At least one blood transfusion was administered to 12.5% of children who received standard chemotherapy, and to 59.5% of children who received intensive chemotherapy. These data also show that a substantial percentage of children did not receive treatment for intensive or high-dose chemotherapy, whereas anemia occurred in almost all patients. Recombinant human erythropoietin (rHuEPO, epoetin alfa) has been shown to be effective in adults in increasing Hb levels and in improving outcomes, including quality of life and survival. The use of epoetin alfa in children has not been extensively studied, and only a few clinical trials have been conducted. CONCLUSIONS: The good results seen in adults, data thus far in pediatrics, and the need for alternatives to transfusions in children make epoetin alfa an attractive treatment option for anemia in pediatric cancer patients. Clinical studies are underway to evaluate the efficacy and safety of epoetin alfa in increasing Hb values and improving outcomes in children with cancer.