A technology assessment report 1 on the use of recombinant human erythropoietin (EPO) in oncological anaemia was abstracted in the Health Technology Assessment Database 2. EPO is most effective in treating anaemia of some haematological malignancies while the results with solid tumours are less conclusive: 40% to 50% of tumour patients do not respond to EPO. Treatment with EPO is an expensive intervention. Early recognition of responders and non-responders is the key to appropriate and cost-effective treatment with EPO. Patients achieving an Hb-increase >2 g/dl are considered as responders. Of the responders, 20% to 30% still require transfusions.
According to another report 3 abstracted in the database 4 EPO increases Hb levels and achieves statistically significant hematologic response rates in patients with anaemia resulting from multiple myeloma, non-Hodgkin's lymphoma, chronic lymphocytic leukemia, and myelodysplastic syndromes. For patients undergoing allogeneic stem-cell transplantation, EPO decreased time to RBC engraftment by 1 to 2 weeks and may decrease the number of RBC units transfused. For patients with anemia resulting primarily from cancer therapy, EPO reduces the odds of transfusion. The overall number needed to treat (NNT) is 4.4 (95% CI 3.6 to 6.1), i.e., four to five patients must be treated to spare one patient from transfusion. The most robust evidence suggests that EPO improves outcomes patients with baseline hemoglobin at or below 10 g/dl.
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