Impact of limiting erythropoiesis‐stimulating agent use for chemotherapy‐induced anemia on the United States blood supply margin

Abstract

This study showed that limiting ESA use in CIA patients would impose considerable pressure on the available blood supply margin given the small margin between usable blood and transfusion demand. The public health consequences of such an outcome should be taken into account when revisions to ESA use are being considered.

Hemoglobin Trends and Anemia Treatment Resulting From Concomitant Chemotherapy in Community Oncology Clinics

“…Vekeman et al 16 modeled the potential decrease in blood supply based on limiting ESA use to patients with concomitant chemotherapy. On the basis of the Vekeman et al models, decreasing ESA use could potentially increase blood supply demand by 10% to more than 100%.…”

Erythropoiesis-stimulating agents in cancer patients: reflections on safety

“…Indeed, as a consequence of such limitations on the use of ESAs, the proportion of patients with mild-to-moderate CIA will increase, as treatment will be initiated later, or even not at all. The rate of RBC transfusions in cancer patients who suffer from CIA will increase, which will have an important impact on blood supply [70]. Moreover, this 'on-off' strategy with very little ESA each time a RBC transfusion needs to be avoided, will most likely not allow a sustained effect on Hb levels, not impact on fatigue and QoL, and may abolish most of the benefits for the appropriate patients.…”

Blood utilization: fostering an effective hospital transfusion culture

“…In cancer patients, using ESAs at low doses and only with concurrent chemotherapy may decrease risks. 1 Limiting ESA use in anemic cancer patients strains the blood supply margin; clinicians must balance the risks of ESAs against transfusion, and decide case-by-case [13]. The Food and Drug Administration (FDA) has issued alerts on the use of ESAs to reverse chemotherapy-induced anemia; Medicare has restricted reimbursement [14].…”