Hematology

Summary This systematic review of 57 trials (involving 9,353 cancer patients) published between January 1985 and April 2005 updates an earlier review covering the period between January 1985 and December 2001 (Bohlius et al).

Summary This multicenter (n=27) randomized, double-blind, placebo-controlled trial enrolled children with cancer (solid tumors, Hodgkin’s disease, acute lymphoblastic leukemia or non-Hodgkin’s lymphoma) and who were anemic and receiving myelosuppressive chemotherapy. The trial’s objective was to assess the effects of a once-weekly dose of epoetin alfa (EPO) on health-related quality of life (HRQOL), hemoglobin (Hb) levels and red blood cell (RBC) transfusions in this group of patients. Outcome measures also included adverse events.

Summary

Summary The European Organization for Research and Treatment of Cancer (EORTC) update their 2004 guidelines (Bokemeyer et al 2004) for the use of erythropoietic proteins in anemic cancer patients. The 2004 guidelines were based on an evaluation of the evidence gleaned from a systematic review of the literature from 1996 to 2003. This 2006 update includes literature published through to 2005.

Summary This multicenter randomized controlled trial employed three arms to evaluate the safety and efficacy of intravenous (IV) iron in the treatment of anemic cancer patients receiving epoetin alfa. The literature indicates that 30-50% of patients receiving epoetin therapy fail to achieve a significant hematological response and that this lack of response may be due to a functional iron deficiency, that is, insufficient iron available for erythropoiesis despite adequate iron stores.

Summary This multicenter (n=15) prospective randomized controlled trial evaluated intravenous (IV) iron’s role in optimizing the response to epoetin beta treatment in anemic cancer patients. According to the literature, 30-50% of patients receiving epoetin therapy fail to achieve a significant hematological response. One possible explanation for this lack of response is a functional iron deficiency where insufficient iron is available for erythropoiesis despite adequate iron stores.

Summary This is an analysis of the transfusion requirements of 132 autologous (n=59) or allogeneic (n=73) peripheral blood stem cell transplants (analogous to the term “bone marrow transplantation”) from a single institution, the Centro de Hematologia y Medicina Interna de Puebla. An aim of Ruiz-Arguelles et al has been to simplify procedures with the effect of decreasing costs and enabling transplants to be performed on an outpatient basis which makes them available to many more patients, with clear benefit in developing countries. Grafting procedures and transfusion policy are described.

Summary Erythropoietin and darbepoetin are commonly used to treat anemia associated with cancer, and though their use carries a risk for venous thromboembolism (VTE), studies have not been done to determine their risk for mortality in these patients. Bennett and colleagues conducted a literature review of phase 3 trials that assessed erythropoietin-stimulating agents (ESAs) in the treatment of patients with cancer. Survival data were available for 51 clinical trials with 13,611 patients and information on VTE for 38 clinical trials with 8172 patients.

Summary The antiplatelet aspects of clopidogrel are well-known, but an association between preoperative use of the drug and postoperative bleeding has been reported in cardiac patients. Because cardiac and orthopedic patients are often of the same age group with similar comorbidities, Lavelle and colleagues examined the effect of the use of clopidogrel and the possible delay in surgical fixation, especially in patients with hip fracture, on morbidity and mortality rates.

Summary Orthotopic liver transplantation (OLT) is associated with major blood loss and need for allogenic transfusions of blood products. However, intraoperative plasma transfusions can lead to a hypervolemic state that increases blood loss and leads to a significantly lower 1-y survival rate. This prospective study evaluated whether anesthesiologists could reduce red blood cell (RBC) transfusion requirements during liver transplantation by eliminating plasma transfusion. Over a 3-y period, 206 successive OLTs were assessed.