Recommendations

The ASCO/ASH recommendations for epoetin and darbepoetin treatment are as follows:

• Epoetin and darbepoetin are equally effective for treating anemia from chemotherapy and have similar risks. These drugs should not be used if you are not receiving chemotherapy or if you are receiving chemotherapy to cure the cancer rather than as a palliative treatment. However, they may be considered if you have low-risk myelodysplastic syndrome (MDS), a disorder of the bone marrow that also may cause anemia, even when chemotherapy is not being given.
• If ESAs are being considered, your doctor should talk with you about the possible risks and benefits of their use. They should be used only if you are receiving chemotherapy and have a hemoglobin level less than 10 g/dL. In addition, the risks and benefits should be compared with the risks and benefits of a red blood cell transfusion. ESAs should not be used unless your hemoglobin level falls below 10 g/dL.
• If used, ESAs should be given at the lowest dose needed to raise your hemoglobin levels just enough for you to avoid a blood transfusion, which may be different depending on your circumstances. The dose may be decreased when that level is reached, or if your hemoglobin level increases more than 1 g/dL within two weeks. If your hemoglobin levels aren't rising after six to eight weeks, ESA treatment is not working and your doctor should stop ESA treatment.
• You and your doctor should be cautious about using these drugs if you have a high risk of developing blood clots. Risk factors include a previous blood clot, recent major surgery, long periods of bed rest or limited activity (such as being in the hospital), and certain types of chemotherapy and hormone therapy. Some types of treatment for multiple myeloma (especially thalidomide [Thalomid] or similar drugs) may also increase your risk of developing a blood clot. Learn more about preventing and treating blood clots.