rHuEPO in surgical oncology

  • Francesco Mercuriali
  • G. Inghilleri


Although the risk of transmitting with blood transfusion infectious diseases such as hepatitis and HIV infections has been dramatically reduced in the last decade and allogeneic blood supply can be currently considered safer than ever in the history of blood transfusion, allogeneic blood transfusion is still viewed as an outcome that, whenever possible, should be avoided.


Autologous Blood Allogeneic Blood Recombinant Human Erythropoietin Allogeneic Blood Transfusion Iron Sucrose 


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  1. 1.
    Abels RI, Larholt KM, Krantz KD et al (1991) Recombinant human erythropoietin (r-HuEPO) for the treatment of the anemia oof cancer. In: Murphy MJ (ed) Blood Cell Growth Factors: Their present and future in Hematology and oncology. alpha Med Press, Dayton, OH, pp 121–141Google Scholar
  2. 2.
    Anastassiades EG, Howarth D, Howarth J, Shanks D, Waters HM, Hyde K, Geary CG, Liu Yin JA, Gokal R (1993) Monitoring of iron requirements in renal patients on erythropoietin. Nephrol Dial Transplant 8: 846–853PubMedGoogle Scholar
  3. 3.
    Asano Y, Okamura S, Shibuya T, Harada M, Niho Y (1988) Growth of clonogeni myeloblastic leukemia cells in the presence of human recombinant erythropoietin in addition to various human recombinant hemopoietic growth factors. Blood 72: 1382–1386Google Scholar
  4. 4.
    Berdel WE, Oberberg D, Reufii B, Thiel E (1991) Studies on the role of recombinant human erythropoietin in growth regulation of human nonhematopoietic tumor cells in vitro. Ann Hematol 63: 5PubMedCrossRefGoogle Scholar
  5. 5.
    Biesma DH, Marx JJM, Kraaijenhagen RJ et al (1994) Lower homologous blood requirement in autologous blood donors after ctreatment with recombinant human erythropoietin. Lancet 344: 367–372PubMedCrossRefGoogle Scholar
  6. 6.
    Blumberg N, Heal JM (1994) Effect of transfusion on immune funcion — Cancer recurrence and infection. Arch Pathol Lab Med 118: 371–379PubMedGoogle Scholar
  7. 7.
    Blumberg NL, Heal JM (1989) Transfusion and host defences against cancer recurrence and infection. Transfusion 29: 236–254PubMedCrossRefGoogle Scholar
  8. 8.
    Braga M, Giannotti L, Gentilini O, Vignali A, Di Carlo V (1997) Erythropoietic response induced by recombinant human erythropoietin in anemic cancer patients candidate to major abdominal surgery Hepato-Gastroenterol 44: 685–690Google Scholar
  9. 9.
    Braga M, Gianotti L, Gentilini O et al (1999) Erythropoiesis after therapy with recombinant human erythropoietin: a dose-response study in anemic cancer surgery patients. Vox Sang 76: 38–42PubMedCrossRefGoogle Scholar
  10. 10.
    Braga M, Gianotti L, Vignali A, Gentilini O, Servida P, Bordignon C, Di Carlo V (1995) Evaluation of recombinant human erythropoietin to facilitate autologous blood donation before surgery in anaemic patients with cancer of the gastrointestinal tract. Br J Surg 82: 1637–1640PubMedCrossRefGoogle Scholar
  11. 11.
    Brugnara C, Colella GM, Cremins J et al (1994) Effects of subcutaneous recombinant human erythropoietin in normal subjects: development of decreased reticulocyte hemoglobin content and iron deficient erythropoiesis. J Lab Clin Med 123: 660–666PubMedGoogle Scholar
  12. 12.
    Bukowski RM (1994) Clinical efficacy of recombinant human erythropoietin (rHuEPO) in the treatment of anemia associated with cancer. Erythropoiesis 5: 108–114Google Scholar
  13. 13.
    Bush RS (1986) The significance of anemia in clinical radiation therapy. Int J Radiat Oncol Biol Phys 12: 2047–2050PubMedCrossRefGoogle Scholar
  14. 14.
    Canadian Orthopedic Perioperative Erythropoietin Study Group (1993) Effectiveness of perioperative recombinant human erythropoietin in elective hip replacement. Lancet 341: 1227–1232Google Scholar
  15. 15.
    Cartwright GE, Lee GR (1971) The anemia of chronic disorders. Br J Haematol 21: 147–152PubMedCrossRefGoogle Scholar
  16. 16.
    Case DC, Bukowski RM, Carey RW et al (1993) Recombinant human erythropoietin therapy for anemic cancer patients on combination chemotherapy. JNCI 85: 801–806PubMedGoogle Scholar
  17. 17.
    Cazzola M, Mercuriali F, Brugnara C (1997) Use of recombinat human erythropoietin outside the setting of uremia. Blood 89 (12): 4248–4267PubMedGoogle Scholar
  18. 18.
    Chun TY, Martin S, Lepor H (1997) Preoperative recombinant human erythropoietin injection versus preoperative autologous blood donation in patients undergoing radical retropubic prostatectomy. Urology 50 (5): 727–732PubMedCrossRefGoogle Scholar
  19. 19.
    D’Ambra M (1997) Preoperative epoetin alfa reduces transfusion requirements in coronary artery bypass graft surgery. Semin Hematol 33 (2 Suppl 2): 73–74Google Scholar
  20. 20.
    De Andrade JR, Jove M, Landon G et al (1996) Baseline hemoglobin as a predictor of risk of transfusion and response to epoetin alfa in orthopedic surgery patients. Am J Orthop 25: 533–542PubMedGoogle Scholar
  21. 21.
    Demetri GD, Kris M, Wade J et al (1998) Quality of life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study. J Clin Oncol 16: 3412–3425PubMedGoogle Scholar
  22. 22.
    Desmond MJ, Thomas MJG, Gillon J, Fox MA (1996) Perioperative red cell salvage. Transfusion 36: 644–651PubMedCrossRefGoogle Scholar
  23. 23.
    Dzik WH, Sherburne B (1990) Intraoperative blood salvage: medical controversies. transf Med Rev IV, n° 3: 208–235Google Scholar
  24. 24.
    Eschbach JW, Kelly MR, Haley NR et al (1989) Treatment of the anemia of progressive renal failure with recombinant human erythropoietin. N Engl J Med 321: 158–163PubMedCrossRefGoogle Scholar
  25. 25.
    Gargano G, Polignano G, Besozzi A et al (1998) The utility of recombinant human erythropoietin (rHuEPO) in preoperative autologous blood donation in gynecological tumor surgery. Proc ASCO 17, abs 351Google Scholar
  26. 26.
    Gillon J, Thomas MJG, Desmond MJ (1996) Acute normovolemic hemodilution. Transfusion 36: 640–643PubMedCrossRefGoogle Scholar
  27. 27.
    Glaspy J, Bukowski R, Steinberg D et al (1997) Impact of therapy with epoetin alfa on clinical outcomes in patients with nomyeloid malignancies during cancer chemotherapy in community oncology practice. J Clin Oncol 15: 1218–1234PubMedGoogle Scholar
  28. 28.
    Goldberg MA (1995) Erythropoiesis, erythropoietin, and iron metabilism in elective suregery: preoperative strategies for avoiding allogeneic blood exposure. Am J Surg (Suppl) 6A: 37S rHEPO in surgical oncology 343Google Scholar
  29. 29.
    Goldberg MA, McCutchen JW, Jove M et al (1996) A safety and efficacy comparison study of two dosing regimen of epoetin alfa in patients undergoing major orthopedic surgery. Am J Orthop 25: 544–552PubMedGoogle Scholar
  30. 30.
    Goodnough LT, Anderson KC, Kurtz S, Lane TA, Pisciotto PT, Sayers MH, Silbertein LE (1993) Indications and guidelines for the use of hematopoietic growth factors. Transfusion 33: 944–959PubMedCrossRefGoogle Scholar
  31. 31.
    Goodnough LT, Price TH, Friedman KD et al (1994) A phase II trial of recombinant human erythropoietin therapy in nonanemic orthopedic patients subjected to aggressive removal of blood for autologous use: Dose, response, toxicity and efficacy. Transfusion 34: 66–72Google Scholar
  32. 32.
    Goya N, Toda F, Nishina S et al (1998) Autotransfusion supported by erythropoietin therapy in transuretral resection of the prostate. Scan J Urol Nephrol 32: 383–387CrossRefGoogle Scholar
  33. 33.
    Groopman JE, Itri LM (1999) Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst 91: 1616–1634PubMedCrossRefGoogle Scholar
  34. 34.
    Heiss MM, Jauch KW, Delanoff C et al (1994) Blood transfusion immunomodulates tumor recurrence: first resulta of a randomized study on autologous versus allogeneic blood transfusion in colorectal cancer. J Clin Oncol 12: 1879–1887Google Scholar
  35. 35.
    Heiss MM, Tarabichi A, Delanoff C, Allgayer H, Jauch KW, Hernadez-Richter T, Mempel W, Beck KG, Schildberg FW, Messmer K (1996) Perisurgical erythropoietin application in anemic patients with colorectal cancer: a double blind randomized study. Surgery 119 (5): 523–527PubMedCrossRefGoogle Scholar
  36. 36.
    Helafaer MA, Carson BS, James CS, Gates J, Della-Lana D, Vander Kolk C (1998) Increased hematocrit and decreased transfusion requirements in children given erythropoietin before undergoing craniofacial surgery. J Neurosurg 88: 704–708CrossRefGoogle Scholar
  37. 37.
    Houbiers JG, Brand A, Van de Watering LM et al (1994) Randomized controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer. Lancet 344: 573–578PubMedCrossRefGoogle Scholar
  38. 38.
    Kettelhack C, Hones C, Messinger D, Schlag PM (1998) Randomized multicentre trial of the influence of recombinant human erythropoietin on intraoperative and postoperative transfusion need in anaemic patients undergoing right hemicolectomy for carcinoma. Br J Surg 85: 63–67PubMedCrossRefGoogle Scholar
  39. 39.
    Kulier AH, Gombotz H, Fuchs G et al (1993) Subcutaneous recombinant human erythropoietin and autologous blood donation before coronary artery bypass surgery. Anesth Analg 76 (1): 102–106PubMedCrossRefGoogle Scholar
  40. 40.
    Kunz J, Maehr R (1995) Management of severe blood loss after tumor resection in a Jehovah’s witness Gynaekol-Geburtshilfliche Rundsch 35 (1): 34–37Google Scholar
  41. 41.
    Kyo S, Omoto R, Hirashima K et al (1992) Effect of human recombinant erythropoietin on reduction of homologous blood transfusion in open-heart surgery. A Japanese multicenter study. Circulation 86 (Suppl II): 413–418Google Scholar
  42. 42.
    Laupacis A, Fergusson D (1998) Erythropoietin to minimize perioperative blood transfusion: a systematic review of randomized trials. The International Study of Peri-operative Transfusion ( ISPOT) Investigators. Transfus Med 8: 309–317Google Scholar
  43. 43.
    Ludvig H, Fritz E (1998) Anemia in cancer patients. Semin Oncol 25 (Suppl 7): 2–6Google Scholar
  44. 44.
    Ludwig H, Fritz E, Leitgeb C et al (1993) Erythropoietin treatment for chronic anemia of selected hematological malignancies and solid tumors. Ann Oncol 4: 161–167PubMedGoogle Scholar
  45. 45.
    Ludwig H, Fritz E, Leitgeb C, Krainer M, Kuhrer I, Sagaster P, Umek H (1993) Erythropoietin treatment for chronic anemia of selected hematological malignancies and solid tumors. Ann Oncol 4: 161–167PubMedGoogle Scholar
  46. 46.
    Macdougall IC, Hutton RD, Cavil I et al (1989) Poor response to treatment of renal anaemia with erythropoietin corrected by iron given intravenously BMJ 299: 157–158Google Scholar
  47. 47.
    Macdougall IC, Tucker B, Thompson J, Tomson CR, Baker LR, Raine AE (1996) A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int 50: 1694–1699PubMedCrossRefGoogle Scholar
  48. 48.
    Matsumoto K, Hukuda S, Ishizawa M, Chano T (1996) Use of preoperative autologous blood donation and erythropoietin for treatment of giant cell tumor of the ischium. Clin Orthop Related Res 326: 246–249CrossRefGoogle Scholar
  49. 49.
    McEvoy GK (ed) (1996) AHFS Drug information 96. American Society of Health System Pharmacists, Bethesda (MD) pp 1036–1047Google Scholar
  50. 50.
    Mercuriali F, Biffi E, Inghilleri G et al (1989) Low hematocrit: limiting factor in autologous blood predonation program. In: Castelli D, Genetet B, Habibi B, Nyddeger Y (eds) Transfusion in Europe. Arnette SA Paris ISBT 291–298Google Scholar
  51. 51.
    Mercuriali F, Gualtieri G, Sinigaglia L et al (1994) Use of recombinant human erythropoietin to assist autologous blood donation by anemic rheumatoid arthritis patients undergoing major orthopedic surgery. Transfusion 34: 501–506PubMedCrossRefGoogle Scholar
  52. 52.
    Mercuriali F, Inghilleri G (1996) Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin 13 (8): 465–478PubMedCrossRefGoogle Scholar
  53. 53.
    Mercuriali F, Inghilleri G (1998) Management of preoperative anemia. Br J Anaesth 81 (Suppl 1): 56–61PubMedGoogle Scholar
  54. 54.
    Mercuriali F, Inghilleri G, Biffi E (1999) Short term low dose perisurgical recombinant human erythropoietin in trauma patients. Haematologica 84 (EHA-4 Abstract book): 217Google Scholar
  55. 55.
    Mercuriali F, Zanella A, Barosi G et al (1993) Use of erythropoietin to increase the volume of autologous blood donated by orthopedic patients. Transfusion 33: 55–60PubMedCrossRefGoogle Scholar
  56. 56.
    Miller CB, Jones RJ, Piantadosi S, Abeloff MD, Spivak JL (1990) Decreased erythropoietin response in patients with the anemia of cancer. N Engl J Med 322: 1689–1692PubMedCrossRefGoogle Scholar
  57. 57.
    Miller CB, Platanias LC, Mills SR, Zahurak ML, Ratain MJ, Ettinger DS, Jones RJ (1992) Phase I-II trial of erythropoietin in the treatment of cisplatinassociated anemia. J Nat Cancer Inst 84: 98–103PubMedCrossRefGoogle Scholar
  58. 58.
    Moliterno AR, Spivak JL (1996) Anemia of cancer. Hematol Oncol Clin North Am 10: 345–363PubMedCrossRefGoogle Scholar
  59. 59.
    Monk TG, Goodnough LT, Brecher ME, Pulley DD, Colberg JW, Andriole GL, Catalona WJ (1997) Acute normovolemic hemodilution can replace preoperative autologous blood donation as a standard of care for autologous blood procurement in radical prostatectomy. Anesth Ana1g 85: 953–958Google Scholar
  60. 60.
    Opelz G, Sengar DP, Mickey MR, Terasaki PI (1971) Effect of blood transfusion on subsequent kidney transplant. Transplant Proc 5: 253–259Google Scholar
  61. 61.
    Pogrel MA, McDonald A (1995) The use of erythropoietin in a patient having major oral and maxillofacial surgery and refusing blood transfusion J Oral Maxillofacial Surg 53 (8): 943–945Google Scholar
  62. 62.
    Price TH, Goodnough LT, Vogler WR et al (1996) The effect of recombinant human erythropoietin on the efficacy of autologous blood donation in patients with low hematocrits: a multicente, randomized, double blind, controlled study. Transfusion 36: 29–36PubMedCrossRefGoogle Scholar
  63. 63.
    Qvist N, Sci D, Boesby S et al (1999) Recombinant Human erythropoietin and hemoglobin concentration at operation during the postoperative period: reduced need for blood transfusions in patients undergoing colorectal surgery. Prospective double-blind placebo-controlled study. World J Surg 23: 30–35Google Scholar
  64. 64.
    Rau B, Schlag PM, Willeke F, Herfarth Ch, Stephan P, Franke W (1998) Increased autologous blood donation in rectal cancer by recombinant human erythropoietin rhEPO. Eur J Cancer 34: 992–998PubMedCrossRefGoogle Scholar
  65. 65.
    Rosenblum N, Levine MA, Handler T, Lepor H (2000) The role of preoperative epoetin alfa in men undergoing radical retropubic prostatectomy. J Urol 163: 829–833PubMedCrossRefGoogle Scholar
  66. 66.
    Rothmann SA, Paul P, Weick JK et al (1985) Effect of cis-diaminedichloroplatinum on erythropoietin production and hematopoietic progenitor cells. Int J Cell Cloning 3: 415–423PubMedCrossRefGoogle Scholar
  67. 67.
    Sears DA (1992) Anemia of chronic disease. Med Clin North Am 76: 567569Google Scholar
  68. 68.
    Silverberg DS, Blum M, Peer G, Kaplan E, laina A (1996) Intravenous ferric saccharate as an iron supplement in dialysis patients. Nephron 72: 413–417PubMedCrossRefGoogle Scholar
  69. 69.
    Skillings JR, Sridhar FG, Wong C et al (1993) The frequency of red cell transfusion for anemia in patients receiving chemotherapy. A retrospective cohort study. Am J Clin Oncol 16: 22–25Google Scholar
  70. 70.
    Stowell CP, Chandler H, Jove M et al (1999) An open-label, randomized study to compare the safety and efficacy of perioperative epoetin alfa with preoperative autologous blood donation in total joint arthroplasty. Orthopedics 22 (1 Suppl): s105 - s112PubMedGoogle Scholar
  71. 71.
    Sunder-Plassmann G, Hörl WH (1995) Importance of iron supply for erythropoietin therapy. Nephrol Dial Transplant 10: 2070–2076PubMedGoogle Scholar
  72. 72.
    Survey of blood banking and transfusion-related practice in Canadian hospitals. Ottawa: Commission of Inquiry on tha Blood System in Canada National Hearings, 199537Google Scholar
  73. 73.
    Taylor JE, Peat N, Porter C, Morgan AG (1996) Regular low-dose intravenous iron therapy improves response to erythropoietin in haemodialysis patients. Nephrol Dial Transplant 11: 1079–1083PubMedGoogle Scholar
  74. 74.
    Thomas MJG, Gillon J, Desmond MJ (1996) Preoperative autologous donation. Transfusion 36: 633–639PubMedCrossRefGoogle Scholar
  75. 75.
    United States General Accounting Office (1997) Blood Supply: Transfusion associated risks. GAO/PEMD-97–1. Washington, DCGoogle Scholar
  76. 76.
    Vamvakas E, More SB (1993) Perioperative blood transfusion and colorectal cancer recurrence: a qualitative statistical overview and meta-analysis. Transfusion 33: 754–765PubMedCrossRefGoogle Scholar
  77. 77.
    Van Camp B (1991) Anemia in cancer. Erythropoiesis 2: 39–40Google Scholar
  78. 78.
    Yamada AH, Lieskovsky G, Skinner DG et al (1993) Impact of autologous blood transfusions on patients undergoing radical prostatectomy using hypotensive anesthesia. J Urol 149: 73–76PubMedGoogle Scholar
  79. 79.
    Yamawaki T, Tanaka H, Takeuchi S, Yanase H, Taniguchi S, Toyoda N (1994) Autologous blood transfusion using recombinant human erythropoietin in radical prostatectomy. Asia Oceania J Obstet Gynecol 20 (2): 147–153CrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2002

Authors and Affiliations

  • Francesco Mercuriali
    • 2
  • G. Inghilleri
    • 1
  1. 1.Immunohematology and Transfusion ServiceIstituto Ortopedico Gaetano PiniMilanoItaly
  2. 2.Immunohematology and Transfusion ServiceIstituto Ortopedico Gaetano PiniMilanoItaly

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