Anemia and Erythropoiesis in Cancer

Approximately one third to one half of patients with cancer are anemic, a condition that diminishes the ability to engage in daily activities and undermines the overall quality of life. Although cancer-related anemia has many causes, one of the most important is inadequate production and impaired utilization of erythropoietin. At any given level of anemia, patients with cancer produce much less erythropoietin compared with a healthy person and, as a result, are unable to compensate for the impaired production and shortened lifespan of red blood cells that occur in this situation. Supplemental recombinant erythropoietin can stimulate the production of red blood cells, correct anemia, and improve quality of life. New dosing regimens offer increased convenience to patients and may hasten drug response. (Advanced Studies in Medicine. 2002;2(17):612-619) T he causes of anemia, a common complication of cancer, are varied, ranging from blood loss to inadequate red blood cell production. The consequences of anemia, while equally diverse, all contribute to undermine quality of life and, perhaps, response to antineoplastic therapies. Although the causes of cancer-related anemia are many, impaired erythropoietin production and impaired responsiveness of erythroid progenitor cells to this hormone are central to its pathophysiology. Therefore, alleviating the anemia of cancer requires an understanding of how erythropoietin stimulates red blood cell formation and how the production of and response to this glycoprotein are altered in patients with cancer.