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Journal de Pharmacie Clinique

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Recombinant human erythropoietins in oncology-haematology: from the prescription survey to the evolution of practice Volume 26, issue 3, Septembre 2007

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Authors
Service de la pharmacie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, Service des maladies du sang et de thérapie cellulaire, Hôpital Saint-Antoine, AP-HP, 75012 Paris, Pharmascript, 18 avenue de Paris, 02200 Soissons

With the increasing role of erythropoietin treatment in patients with cancer-related anemia, we organised a brainstorming about care in our departments, on the basis of a retrospective survey of prescriptions during year 2002. The two main concerned departments were oncology and hematology. Data from 130 medical records were used for analysis. The median hemoglobin level at baseline was 8.9 g/dL [6.3-11.8] and 9.5 g/dL [6.6-11.8] in hematology and oncology, respectively. Oral iron supplementation was prescribed to one third of patients (14% in hematology, 46% in oncology). A standard protocol was systematically followed in oncology: dosage of 30 000 IU/week, doubled if necessary in about 10% of patients. A wide range of doses was prescribed in hematology, which were adjusted to variations of hemoglobin level observed in these diseases (multiple myeloma, non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, myelodysplastic syndromes). The most often prescribed treatment was epoetin beta (86% of prescriptions). Since this survey, EORTC, ASCO/ASH, and FNCLCC recommendations have ruled on patients profile, threshold hemoglobin levels for treatment initiation (between 8 and 12 g/dL), target levels (12-13 g/dL), and epoetin dosage. Hemoglobin level is the follow-up criterion, measured every 4 weeks. Authorities have recently pointed out the importance of complying with Summary of Product Characteristics and administrating the lowest adequate dose. Intravenous iron supplementation is recommended. Epoetin (± G-CSF) is recommended for some anemia of low-to-intermediate I grade myelodysplastic syndromes without 5q deletion. With this work, we evaluated our professional practice and modified it according to experts guidelines, from which we were not so far.