Identification of risk factors for requiring transfusion during front-linechemotherapy for ovarian cancer

Objective. Anemia requiring red blood cell (RBC) transfusion is common in o varian cancer (OC) patients receiving post-debulking surgery chemotherapy. Erythropoietin use has been shown to decrease transfusion requirements in p atients receiving chemotherapy. We sought to identify pretreatment risk fac tors that could identify patients at increased risk for requiring RBC trans fusion during first-line treatment for ovarian cancer. Methods. One hundred seventy-five consecutive patients who received chemoth erapy with either carboplatin-paclitaxel or cisplatin-paclitaxel following debulking surgery for epithelial OC from 1993 to 1996 were identified. No p atient received erythropoietin. Patient characteristics recorded included: age, stage, pre-chemotherapy hemoglobin, nadir hemoglobin, number of cycles and doses of chemotherapy received. The outcome was requiring RBC transfus ion. Independent predictors of requiring RBC transfusion were identified us ing multivariate analyses. Results. Median age of the cohort was 62 years (range, 28-86). Seventy-one and four-tenths percent had FIGO stage III/IV disease. Median prechemothera py hemoglobin was 11 g/dL (range, 7.1-15.4); median nadir hemoglobin was 9. 3 g/dL (range, 6.6-11.1). One hundred nineteen (66%) patients received cisp latin-paclitaxel, and 61 (34%) received carboplatin-paclitaxel. Of 175 pati ents, 31 (18%, 95% CI = 12-23%) required RBC transfusion. Independent risk factors for RBC transfusion were prechemotherapy hemoglobin < 10 g/dL (P < 0.01, odds ratio = 3.78, 95% CI = 1.52-9.44) and carboplatin-paclitaxel ver sus cisplatin-paclitaxel treatment (P = 0.01, odds ratio = 3.14, 95% CI = 1 .27-7.76). Of 175 patients, 40 (22.8%) had a prechemotherapy hemoglobin < 1 0 g/dL. Fifty percent of patients with prechemotherapy hemoglobin < 10 g/dL who received carboplatin-paclitaxel required RBC transfusion, compared wit h 7.7% of patients with hemoglobin > 10 g/dL who received cisplatin-paclita xel. Conclusion. Ovarian cancer patients frequently require RBC transfusion duri ng postdebulking platinum-paclitaxel chemotherapy. Patients with prechemoth erapy hemoglobin < 10 g/dL and those receiving carboplatin-paclitaxel are a t increased risk of requiring RBC transfusion. Early initiation of erythrop oietin use in such patients may reduce transfusion needs. (C) 2001 Academic Press.