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Vol. 15, Art. 56 (pp. 703-717)    |    2014       

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The quality of life of anemic patients with lymphoproliferative disorders treated with red blood cell transfusions and erythropoiesis-stimulating agents

Romanenko N.A.1, Bessmeltsev S.S.1, Potikhonova N.A.1, Romanenko A.E.2, Zenina M.N.1, Abdulkadyrov K.M.1

1Russian Research Institute of Hematology and Transfusiology, Russian Federal of Medical-biological Agency, Saint-Petersburg, 191024, 2nd Sovietskaya str., 16
2Children Hospital of St. Olga, Saint-Petersburg, 194156, str. Zemledelcheskaya, 2

Brief summary

Aims. To assess alteration of quality of life (QoL) in anemic patients with lymphoproliferative disorders (LPD) treated with Red blood cells transfusions (RBCsT) and Erythropoiesis-stimulating agents (ESA). Patients and Methods. There were included 131 anemic patients with LPD (multiple myeloma, low-grade non-Hodgkin\'s lymphoma, chronic lymphocytic leukemia). Median age of patients was 67 years (range 24-85). All persons were divided into two groups: 1st group included patients (n=54) treated with RBCsT, 2nd (n=77) – treated with ESA. Posetive response for ESA considered as achievement of hemoglobine concentration 120 g/L or increase Hb ≥ 20 g/L. QoL was studied with Functional Assessment of Cancer Therapy Anemia subscale (FACT-An) and Fatigue subscale (FACT-F). Results. In the 1st group of patients treated with RBCsT (in average 3.7±0.3 Units) concentration of Hb increased from 70.0±1.6 g/L to 93.1±1.2 g/L. Statistically significant improvement of their QoL was found in FACT-An subscale – from 41.1±2.0 (95% Cl=37.1-45.0) to 34.2±2.1 (95% Cl=30.0-38.3) points (p<0.001; n=54). Improvement of QoL was also found in FACT-F subscale – from 30.2±1.4 (95% Cl=27.8-32.9) to 23.2±1.5 (95% Cl=19.8-26.9) points (p<0.0001; n=54). In the 2nd group positive response for ESA-therapy was found in 52 (67.5%) out of 77 patients: 39 (50.6%) patients achieved the Hb concentration 120 g/L and 13 (16.9%) ones increased Hb more than 20 g/L. The patients with positive response increased the Hb concentration significantly from 88.4±1.4 g/L to 123.1±2.4 g/L (p<0.0001; n=52). We found out improvement of QoL in both subscale: in FACT-An – from 34.5±1.7 (95% Cl=31.1-37.9) to 30.1±1.6 (95% Cl=26.9-33.2) points (p<0.001; n=52) and in FACT-F – from 22.8±1.3 (95% Cl=20.3-25.4) to 19.7±1.2 (95% Cl=17.3-22.1) points (p=0.013; n=52). Conclusions. Both RBCsT and ESA-therapy are able to increase Hb concentration considerably and improve QoL. However the RBCsT patients had more severe anemia and over a period of its correction the RBCsT patients’s planned level of Hb was less than ESA-patietnts’s one therefore their final QoL was less. So using the ESA-therapy can increase higher Hb concentration and improve QoL more than RBCsT. It’s indicating importance of ESA-therapy not as alternative RBCsT method of anemia’s correction but also as a way to prevent decreasing of the Hb induced by toxic effect of chemotherapy and as a method of anemia treatment with which a normal Hb level can be achieved.


Key words

lymphoproliferative disorders, erythropoiesis-stimulating agents, anemia, hemoglobin, red blood cell, red blood cell transfusions, hematologic, quality of life, subscale FACT-An, FACT-F

Reference list

1. Bessmelcev S.S., Romanenko N.A., Abdylkadirov K.M. Sovremennie podhodi k lecheniu anemii y bolnih s onkogematologicheskimi zabolevaniyami// Sovremennaya onkologiya. – 2010. – T. 12, №1. – S. 70-75.


2. Moullet I., Salles G., Ketterer N. et al. Frequency and significance of anemia in non-Hodgkin’s lymphoma patients// Ann. Oncol. – 1998. – Vol. 9. – P. 1109-1115.


3. Zupanić-Krmek D.,  Lang N.,  Jurcić D. et al. Analysis of the influence of various factors on anemia in patients with lymphoid malignancies// Acta Clin. Croat. – 2011. – Vol. 50, №4. – P. 495-500.


4. Truong P.T., Parhar T., Hart J. et al. Population-based analysis of the frequency of anemia and its management before and during chemotherapy in patients with malignant lymphoma// Am. J. Clin. Oncol. – 2010. – Vol. 33, №5. – P. 465-468.


5. Romanenko N.A., Abdylkadirov K.M. Patogeneticheskaya korrekciya anemii eritropoezstimyliryushimi preparatami y bolnih limfoproliferativnimi zabolevaniyami// Onkogematologiya.- 2011.- №3.- S. 39-49.


6. Gricaev S.V., Davaasambyy B., Romanenko N.A., Abdylkadirov K.M. Otbor bolnih dlya terapii helatorami jeleza// Klin. Onkogematologiya. – 2013. – T.6, №2. – S. 204-209.


7. Khorana A.A., Francis C.W., Blumberg N. et al. Blood Transfusions, Thrombosis, and Mortality in Hospitalized Patients With Cancer// Arch. Intern. Med. – 2008. – Vol. 168, №21. – P. 2377-2381.


8. Leitch H.A., Vickars L.M. Supportive care and chelation therapy in MDS: are we saving lives or just lowering iron?// Hematology Am. Soc. Hematol. Educ. Program. – 2009. – P. 664-672.


9. Romanenko N.A., Bessmelcev S.S., Berkos M.V., Rozanova O.E., Abdylkadirov K.M. Prognosticheskaya znachimost ryada laboratornih pokazatelei krovi pri ispolzovanii preparatov, stimyliryushih eritropoez y bolnih limfoproliferativnimi zabolevaniyami s anemiei// Ter. Arhiv. – 2013. – T.85, №8. – S.81-86.


10. EORTC guidelines for the use of erythropoietic proteins in anemic patients with cancer: 2006 update/ C. Bokemeyer, M.S. Aapro, A. Courdi et al.// Eur. J. Cancer. – 2007. – Vol. 43. – P. 258-270.


11. Cazzola M., Beguin Y., Kloczko J. et al.Once-weekly epoetin beta is highly effective in treating anaemic patients with lymphoproliferative malignancy and defective endogenous erythropoietin Production// Br. J. Haematol. – 2003. – Vol. 122, №3. – P. 386-393.


12. Haioun C., Salar A., Pettengell R. et al.Anemia and erythropoiesis-stimulating agent administration in patients with non-Hodgkin lymphoma treated with cyclophosphamide, doxorubicin, vincristine, and prednisolone with/ without rituximab chemotherapy: results from an observational study// Leukemia & Lymphoma. – 2011. – Vol. 52. – P. 796-803.


13. Romanenko N., Kostroma I., Abdulkadyrov K. Comparative study the efficacy of different erythropoiesis-stimulative agents in anemic patients with lymphoproliferative disorders// Haematologica - The Hematology journal. – 2013. – Vol. 98, Suppl. 1. – S 648.


14. Campos M.P.O., Hassan B.J., Riechelmann R., Del Giglio A. Cancer-related fatigue: a practical review// Annals of Oncology. – 2011. – Vol.22, N6. – P. 1273–1279.


15. Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue// Semin Hematol. – 1997. –Vol. 34 (3 Suppl 2) . – P. 13-19.


16. Christodoulou C., Dafni U., Aravantinos G. et al. Effects of Epoetin-α on Quality of Life of Cancer Patients with Solid Tumors Receiving Chemotherapy// Anticancer Research. – 2009. –Vol. 29. – P. 693-702.


17. Romanenko N.A. Bessmelcev S.S., Karmackaya I.I., Potihonova N.A., Abdylkadirov K.M. Effektivnost eritropoezstimyliryushih preparatov i ih vliyanie na kachestvo jizni bolnih s anemiei pri limfoproliferativnih zabolevaniyah// Kaz.med.jyrnal. – 2013. – T. XCIV, №4. – S. 468-473.


18. Yellen S.B., Cella D.F., Webster K. et al. Measuring fatigue, and other anemia related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system// J Pain Symptom Manage.–1997.– Vol.13.– P. 63-74.


19. Yoshimura A., Kobayashi K., Fumimoto H. et al. Cross-Cultural Validation of Japanese Functional Assessment of Cancer-Therapy Anemia (FACT-An)// J Nippon Med Sch.– 2004.–Vol. 71,N5.– P. 314-322.


20. Instrykciya po primeneniu komponentov krovi (Ytverjdennaya Prikazom Minzdrava ot 25 noyabrya 2002 goda RF №363 «Ob ytverjdenii Instrykcii po primeneniu komponentov krovi»)// [Elektronnii resyrs]// http://www.zdrav.ru/library/regulations/detail.php?ID=26150.


21. Pravila klinicheskogo ispolzovaniya donorskoi krovi i (ili) ee komponentov/ Prikaz ot 2 aprelya 3013 g. №183n «Ob ytverjdenii pravil klinicheskogo ispolzovaniya donorskoi krovi i (ili) ee komponentov» [Elektronnii resyrs]// http://www.transfusion.ru/2013/08-29-1.pdf.


22. Rizzo J.D., Brouwers M., Hurley P. et al. American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer// Blood. – 2010. – 116, N20 . – P. 4045-4059.


23. Vadhan-Raj S., Zhou X., Sizer K. et al. Impact of safety concerns and regulatory changes on the usage of erythropoiesis-stimulating agents and RBC// The Oncologist.– 2010.– Vol. 15.–P.1359-1369.