Risk model for severe anemia requiring red blood cell transfusion after cytotoxic conventional chemotherapy regimens

Purpose: Cancer patients frequently experience anemia as a consequence of m yelosuppressive therapy or bane marrow invasion. Patients and Methods: A risk model for chemotherapy-induced severe anemia r equiring RBC transfusions (SARRT) within 31 days after the administration o f chemotherapy was delineated in the cohort of cancer patients treated with chemotherapy in the Department of Medicine of Centre Leon Berard in 1996 ( CLB-1996), The risk model was tested on a series of 797 patients treated in 1997 (CLB-1997) and on 295 patients included in a multicenter prospective series (ELYPSE 1), Results: One hundred seven of the 1,051 patients of the CLB-1996 cohort (10 %) experienced SARRT, In univariate analysis, only female sex, performance status greater than 1, hemoglobin level less than 12 g/dL before chemothera py on day 1 (d1), and d1 lymphocyte count less than or equal to 700/mu L si gnificantly correlated with the risk of Start. Using logistic regression, d l hemoglobin level less than 12 g/dL (odds ratio [OR] = 14.0; 95% confidenc e interval [CI], 7 to 30), performance status greater than 1 (OR = 2.2; 95% CI, 1.4 to 3.5), and d1 lymphocyte count a 700/mu L (OR = 1.7; 95% CI, 1.1 to 2.6) were identified as independent risk factors For SARRT. These three factors were given arbitrary risk coefficients of 3, 1, and 1 respectively , and a risk score for each individual patient was obtained by adding the c oefficients. The calculated probability of RBC transfusions was 30% for pat ients with a score greater than or equal to 4, and 11%, 4%, and 1% in patie nts with a score of 2 or 3, 1, and 0 respectively. This model was then test ed and validated in the CLB-1997 and ELYPSE 1 series. Conclusion: This risk index could be useful to identify patients at high ri sk for chemotherapy-induced SARRT who might be appropriate candidates for p rophylactic erythropoietin treatment. (C) 1999 by American Society of Clini cal Oncology.