Prise en charge de l’anémie en oncologie: modalités pratiques, efficacité des agents stimulant l’érythropoïèse (ASE) [darbépoétine alpha] et place de la transfusion

• Published in: Oncologie (Paris, France) France), 2012-02, Vol.14 (2), p.123-130
• Main Authors: Levaché, B., Sousselier, B., Cany, L., Maguire, C., Fagnani, F.
• Format: Article
• Language: fre
• Subjects: Anaemia; Anémie; Anémies. Hémoglobinopathies; Blood transfusion; Cancer; Darbepoetinalpha; Darbépoétine alpha; Evaluation; Hemopathies; Maladies des hématies; Medicine; Medicine & Public Health; Mise au Point; Oncology; Sciences biologiques et medicales; Sciences medicales; Transfusion sanguine; Tumeurs; Tumeurs multiples. Tumeurs solides. Tumeurs chez l'enfant (généralités); Évaluation
• ISSN: 1292-3818; 1765-2839
• DOI: 10.1007/s10269-012-2123-3

Patients andmethod: An observational study was carried out in an oncology department that had initiated an active anaemia management strategy using ESA (darbepoetin-alpha) in order to observe the resulting changes seen in the use of transfusions and to assess the effectiveness of this strategy in controlling anaemia in clinical practice. Data were gathered from medical files of all patients treated with ESA for anaemia during two successive periods of a year. The first period corresponded to the implementation of this strategy within the unit (from September 2006), and the second period (from April 2008) could be regarded as a phase of stable practice. Results: The percentage of patients treated with ESA increased slightly, from 23.3 to 26.8%, for the active group, which remained almost identical during the two periods (897–899 patients). The average number of ESA injections per patient decreased (3.21 compared to 2.88, NS). The number of transfusions reduced by about 19% across the two periods. Analysis of the effectiveness of treatment was carried out on a cumulative number of 339 patients, who received a continuous sequence of ESA injections during the same course of chemotherapy, with at least three injections of ESA. This corresponded to 205 patients in period one and 134 patients in period two. Effectiveness was defined as a function of the changes in Hb level (ΔHb) in three categories: 39.8% of patients were judged to have responded well (ΔHb ≥ 1 g/dl), 36.9% as having had an intermediate response (0 ≤ δHb < 1 g/dl) and if ΔHb < 0, they were classified as not responded (33.3%). Improvements in Hb levels during successive ESA injections were more significant for patients presenting with initially low Hb levels. Conclusions: The results obtained show that the effectiveness of darbepoetin-alpha observed in clinical practice is in agreement with that demonstrated in clinical trials, and confirms that treatment with darbepoetin-alpha substantially decreases the need for transfusions. Résumé: Patients et méthode: Une étude observationnelle a été réalisée dans un service d’oncologie ayant initié une stratégie active de prise en charge de l’anémie par agents stimulant l’érythropoïèse (ASE) [darbépoétine alpha] afin d’observer en pratique courante l’évolution du recours à la transfusion qui en a résulté et d’évaluer l’efficacité de cette stratégie sur le contrôle de l’anémie. Les données ont été recueillies dans les dossiers médicaux de la totalité des patie