ERITROPOETIN AND ANEMIA IN ONCOLOGY DivisiHematologi & Onkologi MedikDepartemen Ilmu Penyakit Dalam FK-USU/SUP H!"dam Malik Medan #$%#Dairion &atot' Savita Handayani'Soegiarto &aniAnaemia in Cancer Represents a Substantial BurdenAnaemia is highly prevalent affects up to 90% of patients ith cancer! depending on malignancy and chemotherapy type"!#Anaemia is associated ithpoor clinical outcome $increased mortality ris%! impaired tumour control&'( reduced )uality of life $*o+&,atigue - one of the main symptoms of anaemia affecting patient *o+1. Groopman & Itri. JNCI 1999; 91: 161634 2. Knight et al. Am J Med 2004;116 (Suppl !": 11S26S3. #oullet et al. Ann Oncol 199$; 9: 11091%4. &utter'a(h & Gutten'erger. Int J Radiat Oncol Biol Phys 2000; 4$: 134%%0%. )aro et al. Cancer 2001; 91: 2214216. *an +elle & )o(,u-t. Crit Rev Oncol Hematol 2003; 4: 111.ncidence of Anaemia is /igh in 0atients ith Cancer.er/i/tent0 re(urrent 1i/ea/e2e3l- 1iagno/e1In remi//ion0 10 20 30 40 %0 6045erall.atient/ 3ith anaemia (6"!naemia: 7' 812 g01l at enrolment9uropean )an(er !naemia Sur5e- (9)!S": &u13ig et al. Ann Oncol 2002; 13 (Suppl %": 169 ;!623.enal impairment#alignan(- it/el@+eguin. Leuk Lymphoma 199%; 1$: 41321&u13ig & AritB. emin Oncol 199$; 2% (Suppl ": 26&u13ig et al. Hematol J 2002; 3: 12130Coo1 & 7ru/he/D-. J Clin Invest 199%; 9%: 16%09#er(a1ente et al. Cancer !reat Rev 2000; 26: 30311#-elo/uppre//ion '- (hemotherap- an10or ra1iotherap-+loo1 lo//Anaemia Adversely .mpacts 3rgan ,unction in 0atients ith Cancer)entral ner5ou/ /-/tem>e1u(e1 (ogniti5e @un(tione1u(e1 per@u/ionAlui1 retention>epro1u(ti5e @un(tion#en/trual 1i/tur'an(e/&o// o@ li'i1oImpoten(eImmune /-/temImmune 1e@i(ien(-!1apte1 @rom &u13ig & Stra//er. emin Oncol 2001; 2$ (Suppl $": 14 Anaemia Substantially 4ecreases *uality of +ife!naemia>e1u(e1 a'ilit- to 3orDe1u(e1 eFer(i/e (apa(it- Anaemia Reduces Survival in 0atients ith Cancer1%0100%00#ean in(rea/e in mortalit- ri/D (6"&ung12%%2%.ro/tate &-mphoma 7ea1 & 2e(D45erall1964666%66%6S-/temati( re5ie3 o@ 60 /tu1ie/ )aro et al. Cancer 2001; 91: 2214210athophysiology of 2alignancy5.nduced Anaemia!IS: !naemia?In1u(ing Su'/tan(e; +AG?9: +ur/t?Aorming Gnit?9r-throi1; )AG?9: )olon-?Aorming Gnit?9r-throi1; E2A: Eumour 2e(ro/i/ Aa(tor; I&: InterleuDin; IA2: Inter@eronEumour (ell/!(ti5ate1immune /-/tem!naemia)-toDine/ (E2A: I&?10: IA2?">e1u(e1 Impaire1Suppre//e1er-thropoietiniron +AG?9pro1u(tion utili/ation)AG?9E2A#a(rophage/9r-throphago(-to/i/:1-/er-thropoie/i/!IS9r-thro(-te/H /hortene1 /ur5i5al 2o3rou/ian. Med Oncol 199$; 1% (Suppl 1": S192$Anaemia is a 0redictive ,actor for 0oor 0rognosis in 0atients ith Cancer.oor progno/i/!naemiaSele(tion pre//ure!poptoti( 1e@i(ien(- )hemo? an1 ra1io?re/i/tan(eGeneti(in/ta'ilit-!ngio?gene/i/Eumour h-poFia!((elerate1 progre//ionIn(rea/e1 rate o@ 1i/tant meta/ta/e/Management Options for Anaemia in Patients with Cancer3ptions for Anaemia 2anagement in 0atients ith Cancer2o treatment(606"Iron alone(6"9poetin(1$6"Eran/@u/ion(1%6"9uropean )an(er !naemia Sur5e- (9)!S": &u13ig et al. Ann Oncol 2002; 13 (Suppl %": 169 ;!623.eti(ulo(-te+AG?9 )AG?9!popto/i/3ithout er-thropoietin+AG?9: +ur/t?Aorming Gnit?9r-throi1)AG?9: )olon-?Aorming Gnit?9r-throi1>e1 'loo1 (ell/Ai/her. $'p Biol Med 2003; 22$: 114:rythropoietic agents produce a smooth and sustained /b increase(ster&or") Med Oncol *++,-*.#uppl *%/012+Lud3i" et al) N $n"l J Med *++4-566/*7+52+9r-thropoieti( agent/Eran/@u/ion/0 30 60 90 120 1%0 1$0 2107' (g01&"