What are the American Society of Hematology (ASH) and ASCO recommendations for use of erythropoiesis-stimulating agents (ESAs) in multiple myeloma (MM)?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

A joint American Society of Hematology (ASH) and ASCO clinical practice guideline on the use of erythropoiesis-stimulating agents (ESAs) in cancer was updated in 2019. The specific recommendations for patients with multiple myeloma receiving concurrent chemotherapy include the following [134] :

  • Depending on clinical circumstances, ESAs may be offered to patients with chemotherapy-associated anemia whose cancer treatment is not curative in intent and whose hemoglobin (HgB) has declined to < 10 g/dL; red blood cell (RBC) transfusion is also an option, depending on the severity of the anemia or clinical circumstances.
  • ESAs should not be offered to patients with chemotherapy-associated anemia whose cancer treatment is curative in intent.
  • In patients with myeloma, clinicians should observe the hematologic response to cancer treatment before considering an ESA. Particular caution should be exercised in the use of ESAs concomitant with treatment strategies and diseases where risk of thromboembolic complications is increased. In all cases, blood transfusion is a treatment option that should be considered.
  • In patients who do not respond to ESA treatment within 6 to 8 weeks, the ESA should be discontinued and the patient should be reevaluated for underlying tumor progression, iron deficiency, or other etiologies for anemia.
  • Iron replacement may be used to improve HgB response and reduce RBC transfusions for patients receiving ESA with or without iron deficiency.

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