Caution Regarding Use Of Erythropoiesis-Stimulating Agents In Cancer Patients Recommended In New Guideline

An updated joint guideline by the American Society of Hematology (ASH), the world’s largest professional society concerned with the causes and treatment of blood disorders, and the American Society of Clinical Oncology (ASCO) advises physicians about the appropriate use of erythropoiesis-stimulating agents (ESAs), a class of drugs that stimulate the bone marrow to produce more red blood cells, to treat cancer patients with chemotherapy-induced anemia.

While the guideline cautions that ESAs are associated with shorter survival and increased risk of thromboembolism — blood clots — tumor progression and stroke, it also recognizes their major benefit of reducing the need for red blood cell transfusions, which can potentially cause serious infections and adverse reactions in the immune system.

“This updated guideline offers clinicians the latest synthesis of the medical evidence surrounding use of ESAs in patients with cancer, including appropriate cautions where evidence is lacking or where risks may outweigh the use of ESAs,” said J. Douglas Rizzo, MD, MS, Co-Chair of the guideline panel and Professor of Medicine at the Medical College of Wisconsin.

Those risks may include thromboembolism or even death, according to new data cited in the guideline, which suggests that physicians avoid the use of ESAs in cancer patients who are not receiving chemotherapy, except for those with myelodysplastic syndrome (MDS). At the same time, the guideline confirms the effectiveness of ESAs in sparing patients the need for transfusions, which can substantially impact Quality of Life. By recommending that physicians discuss individual risks and benefits of ESAs and blood transfusion with patients prior to therapy, the guideline recognizes the critical role of shared decision-making between the patient and the physician.

In addition to outlining the clotting risks of ESAs, the guideline makes specific recommendations on usage and provides insights into disease progression and patient survival. The guideline also details new thresholds for initiation and modification of ESAs, which are consistent with current US FDA labeling.

Originally published in 2002 and last updated in 2007, the guideline was derived from analysis of individual patient data, various medical literature, and systematic reviews of published clinical trials. In developing the update, panel members considered all relevant literature published between January 2007 and January 2010. Additional evidence was considered when it was considered pertinent to each section of the updated guideline.

“These guidelines touch on almost all aspects of the use of ESAs in patients with cancer and MDS, as well as secondary issues, such as the role of iron supplementation,” said Samuel Silver, MD, a member of ASH’s Committee on Practice and Professor of Internal Medicine at the University of Michigan. “These are issues that confront practicing hematologists and oncologists on a daily basis, and we hope that these evidence-based recommendations will influence practice standards and result in better care for patients.”

For more information:
Rizzo JD, Brouwers M, Hurley P, Seidenfeld J, Arcasoy MO, Spivak JL, Bennett CL, Bohlius J, Evanchuk D, Goode MJ, Jakubowski AA, Regan DH, Somerfield MR. American Society of Clinical Oncology/American Society of Hematology Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin in Adult Patients With CancerJ Clin Oncol. 2010 Nov 20;28(33):4996-5010. Epub 2010 Oct 25.

This article was first published online at Onco'Zine - The International Cancer Network

'Explore the Mystery of Blood' Teaches High School Students About Blood and Career Opportunities in the Field of Hematology

The American Society of Hematology (ASH), the world's largest professional society concerned with the causes and treatment of blood disorders, and Scholastic, the global children's publishing, education, and media company, are launching "Explore the Mystery of Blood," a dynamic science curriculum designed to spark interest in the fields of science and medicine, in addition to exposing students to exciting career opportunities in hematology.

"Many hematologists may remember watching a cartoon in grade school about Hemo the Magnificent, which made learning about blood really fun," stated Nancy Berliner, MD, ASH President. "Now ASH has the opportunity to convey this excitement to a new generation of high school students. We are really excited to have developed this quality program with Scholastic."

This hands-on, interactive learning experience will engage students in learning about blood functions as well as common disorders through colorful imagery and the actual examination of blood smears under a microscope. The program align with national education standards for science, technology, and life skills. It includes lesson plans built on themes from the hematology documentary "Blood Detectives" and information from 'Blood, The Vital Connection ", a website designed to educate the public about the importance of healthy blood.

As part of the program, students will watch "Blood Detectives" (a DVD is included with the materials) where they will see real-life hematologists at work in clinical and research settings helping to treat and cure hematology patients with life-threatening blood diseases . Follow-up activities allow students to see what it is like to be a hematologist by observing blood from an unhealthy patient and learning about how this information helps doctors and draw conclusions Determining accurate diagnoses.

"Scholastic is pleased to be working with The American Society of Hematology to provide resources to help high school core teachers foster their students in scientific investigation skills." Said Ann Amstutz-Hayes, Vice President of Scholastic InSchool.

This curriculum is being distributed to 50,000 high school science teachers and science club advisors nationwide, reaching more than 4 million students. It will also be available for download.

The program "Explore the Mystery of Blood" was made possible in part by the Wallace H. Coulter Foundation.

Novel Treatments Demonstrate Improvements in Overall Survival (OS) and Response Rates (RR) in Difficult to Treat forms of Leukaemia and Lymphoma

The use of dexamethasone early in the treatment of children with acute lymphoblastic leukemia (ALL), the most common type of childhood cancer, may help reduce the risk of relapse. This is the conclusion from study results presented during the 50th Annual Meeting of the American Society of Hematology (ASH) in San Francisco, CA (December 6 – 9)

Additional research featured during the annual meeting included: the potential role of a combination therapy regimen that includes rituximab as the new standard first-line therapy for the treatment of advanced chronic lymphocytic leukemia, the examination of pralatrexate or 10-propargyl-10-deazaaminopterin (PDX), for the treatment of peripheral T-cell lymphoma in the largest prospective study of this subset of patients, and the results of the first study examining a promising new molecular target for the treatment of B-cell non-Hodgkin lymphoma.

'By conducting ongoing research with new, investigational treatments as well as with different combinations of existing treatment options that have been used for years, we are working to improve the survival of our patients with leukemia and lymphoma,' explained Dr. Linda Burns, MD, Professor of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN. 'The research presented today showcases the great advances we are continuously making in treating various blood cancers.'

Leukemia and lymphoma are two of the most common blood cancers. Leukemias are categorized based on the speed at which the cancer grows – acute leukemias grow quickly while chronic leukemias develop at a slower rate. Leukemias also are categorized as lymphocytic or myelogenous depending on whether they affect lymphocytes (a type of white blood cell) or stem cells found in the bone marrow. According to the National Cancer Institute, each year there are approximately 44,000 new cases and 22,000 deaths associated with leukemia in the United States.

Lymphoma is cancer of the lymphatic system that begins with a change in the lymphocytes, impairing the ability of the body’s immune system to fight infection. Lymphomas are divided into two categories: Hodgkin lymphoma and non-Hodgkin lymphoma. Most non-Hodgkin lymphomas are B-cell lymphomas, which are further classified into 14 different sub-types based on the stage of cell development during which the B cell has been affected. The rest are T-cell lymphomas, which affect another type of white blood cell. There are approximately 66,000 new cases of lymphoma and nearly 20,000 deaths each year in the United States according to the National Cancer Institute.

Also read blog entry:

• Fostamatinib Disodium shows promise in the treatment of Diffuse Large B-Cell Lymphoma and Chronic Lymphocytic Leukemia
• Dexamethasone can Eliminate One-Third of All Relapses in Childhood Acute Lymphoblastic Leukemia
• New Drug Shows Promise in the Treatment of Patients With Relapsed or Refractory Peripheral T-Cell Lymphoma
• Immunochemotherapy with Fludarabine, Cyclophosphamide, and Rituximab Improves Response Rates and Progression-Free Survival of Previously Untreated Patients with Advanced Chronic Lymphocytic Leukemia.