Prior red blood cell transfusions in cancer patients increase the risk of subsequent transfusions with or without recombinant human erythropoietin management.
Couture et al. perform an interesting meta-analysis of 5 previously reported, placebo-controlled epoetin alfa studies in anemic cancer patients on chemotherapy. Their conclusions are simple and intuitive: previous blood transfusion and low baseline hemoglobin predict for future blood transfusions. However, I am not sure if their suggestion that earlier treatment with epoetin alfa necessarily prevents transfusion can be conclueded from the data presented here. Early intervention with epoetin will lead to less transfusion in those patients whose hemoglobins respond, but it will not in those patients who do not respond. Some patients required just one transfusion, while others required more than one, but we do not have any information about the bone marrows, performance status, EPO levels or iron stores of those patients who did require more than one transfusion. The ability to predict a response to an erythropoietic agent continues to be a very important goal and the data and analysis in this paper bring us a bit closer to that goal.
– David H. Henry