Comparison of transfusion rates between erythropoietic stimulating agents in gynecologic oncology patients with chemotherapy induced anemia

Abstract

5092 Objective: Chemotherapy induced anemia (CIA) commonly occurs in gynecologic oncology patients. This often leads to treatment with erythropoietic stimulating agents in order to prevent chemotherapy delays, dose modifications and transfusion of red blood cells. Our goal was to determine the subsequent transfusion rates after treatment failure with either darboetin alpha (DARB) or epoetin alpha (EPO). Methods: A single institution retrospective chart review was performed reviewing patients from January 2003 to September 2004 who received either DARB or EPO for CIA (Hgb ≤ 10.0). Data collection variables included patient demographics, cancer diagnosis, chemotherapy treatment(s), laboratory data, erythropoeisis stimulation data, and transfusions. Sample size calculations were set to detect a 20% transfusion rate difference between the two groups. Chi-square, Fisher exact test and student t-tests were used for statistical analysis. Results: 123 patients were eligible for analysis (60 DARB; 62 EPO). 93% of DARB patients received 200mg every other week, while 86% of EPO patients received 40,000 U weekly. Variables that were controlled for between the DARB and EPO groups included age, race, tumor type, histology, previous chemotherapy, number of chemotherapy agents, weeks of erythropoietic stimulation, baseline serum levels of creatinine and hemoglobin, and change in hemoglobin. Although the mean baseline Hgb and change in Hgb was similar for each group (DARB=11.2, 2.5 & EPO=11.3, 2.3), 21 (35%) of the DARB patients received a transfusion of packed red blood cells compared to 12 (19%) of EPO patients (p=0.05). Conclusions: This retrospective analysis powered to detect differences in transfusion rates revealed a statistically significant difference in transfusion rates between DARB and EPO for the treatment of CIA. Although subject to the limitations to a retrospective study, we believe this data warrants a randomized prospective trial in gynecologic oncology patients with careful attention to the timing of initiation of treatment, dosing regimens, and titration of growth factor. No significant financial relationships to disclose.