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Crit Rev Oncol Hematol. 2013 Aug;87(2):132-9. doi: 10.1016/j.critrevonc.2012.12.010. Epub 2013 Jan 26.

Erythropoiesis-stimulating agents (ESAs): do they still have a role in chemotherapy-induced anemia (CIA)?

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  • 1The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada.



Anemia in cancer patients can be a result of the underlying cancer or related to treatment. Erythropoiesis-stimulating agents (ESAs) are an important option for many patients with chemotherapy-induced anemia, but are immersed in controversy. This article aims to reconcile conflicting opinions and provide expert guidance for appropriate ESA use.


Teleconference, email, and a face-to-face meeting were used to assess ESA therapy "interpretive" data, which included two current meta-analyses, expert guidelines, and regulatory approved indications from Canada, Europe, and the USA.


Risks and benefits are associated with both red blood cell transfusions and ESA therapy, including improvements in hemoglobin levels and quality of life. ESAs have been associated with concerns regarding survival and progression of cancer, particularly when used in patients with cancer-related anemia.


Although safety concerns do exist, ESA therapy can be considered for use in patients with chemotherapy-induced anemia in accordance with Health Canada labeling.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.


Anemia; Chemotherapy-induced anemia; ESA; Erythropoiesis-stimulating agents

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