ROLE OF RECOMBINANT-HUMAN-ERYTHROPOIETIN IN ONCOLOGICAL SURGERY

Anemia is common in cancer patients, especially in those with more adv anced stages of progressive tumor growth, the frequency varying on typ e of cancer, stage and chemotherapy or radiation therapy used. The pat hophysiology is multifactorial. However the most common anemia is the anemia whose features are similar to those seen in other chronic disea ses (anemia of chronic disease - ACD). The pathophysiological mechanis ms are: a mild decrease in red blood cells survival, a decreased re-ut ilization of bone marrow iron stores and an inadequate erythropoietin response to the degree of anemia. When anemia cannot be corrected thro ugh the administration of hematinics and anemia is severe enough to si gnificantly restrict physical activity and quality of life, blood tran sfusion is requested. It has been reported that the percentage of pati ents requiring transfusion ranges from 20 to 50%. The transfusion of a llogeneic blood exposes the recipient to immunological and infectious risks. There is evidence that allogeneic blood transfusions can have i mmunologic consequences and some argue that these immune changes can a dversely affect the prognosis in cancer patient. Although this is stil l controversial, until it can be shown that blood transfusion is not h armful in the long term to patients with cancer, it seems reasonable t o avoid it whenever possible. Recently the availability of recombinant DNA technology permitted large scale production of recombinant human erythropoietin (rHuEPO). To date several clinical trials employed rHuE PO in anemic cancer patients with various solid tumors both on and off chemotherapy. All these studies have reported a significantly increas e in Hct than placebo in more than 50% of the treated patients. The pr oblem of correcting anemia and of blood transfusion is even more impor tant when cancer patients become candidate to major surgery. In such s ituation, the transfusion of a consistent number of units is generally required to cover the surgical blood loss. The use of homologous bloo d in surgery can be substantially reduced by the introduction of autol ogous blood transfusion (ABT) programmes in association with rHuEPO. A number of experimental and clinical studies on the effects of rHuEPO on AB donation and on erythropoiesis in the peri-operative period have demonstrated that it resulted to be effective in stimulating erythrop oiesis, with a consequent increase in the volume of red cells produced during the course of treatment and in the number of units predeposite d. It was also effective in correcting anemia induced by collection of blood units. The efficacy of rHuEPO in increasing the volume of autol ogous blood the patient can predeposit before surgery has been demonst rated also in patients with ACD and cancer. No significant adverse eff ects of rHuEPO administration have been reported in any of the studies published to date. It can be concluded that rHuEPO therapy may be saf e and effective in selected surgical patients, in stimulating erythrop oiesis, in expanding the circulating RBCs mass, in increasing the volu me of AB that can be collected pre operatively and, consequently, in r educing the exposure to homologous blood. Therapy with rHuEPO may prov e to be a useful addition to existing strategies of blood conservation to minimize exposure to HB.