Evaluation of anaemia in patients with multiple myeloma and lymphoma: findings of the European CANCER ANAEMIA SURVEY

Abstract

Objectives: Until recently, no prospective epidemiologic survey of lymphoma and multiple myeloma (L/MM) in European cancer patients had been conducted; furthermore, data on prevalence, incidence, and treatment patterns of L/MM were limited or unavailable. Here we define anemia prevalence, incidence, and treatment patterns, and identify anemia risk factors in European L/MM patients.

Methods: Data for a subgroup of 2360 L/MM patients in the European Cancer Anaemia Survey (ECAS) were analyzed; variables included age, gender, tumor type/stage, cancer and anemia treatment, WHO performance status, and hemoglobin (Hb) levels.

Results: 2316 patients were evaluable (1612 L and 704 MM). Anemia rate at enrollment was 52.5%. At enrollment, Hb levels correlated significantly with WHO scores (r = -0.306, P < 0.001). Anemia prevalence during ECAS was 72.9% (MM, 85.3%; non-Hodgkin's lymphoma, 77.9%; Hodgkin's disease, 57.4%); incidence in chemotherapy patients was 55.4%. Only 47.3% of patients anemic any time during ECAS received anemia treatment; overall Hb nadir for initiating treatment was 8.9 g/dL (epoetin, 9.5 g/dL; transfusion, 8.2 g/dL). Factors found to significantly (P < 0.03) increase anemia risk were low initial Hb, female gender, persistent/resistant disease, and platinum chemotherapy.

Conclusions: L/MM patients have a high prevalence and incidence of anemia; however, anemia is not optimally treated. Anemia is common in L/MM patients and, given its known adverse impact on physical functioning and quality-of-life variables including fatigue and cognitive function, anemia management should be an integral part of their care. Predictive factors identified by ECAS may help clinicians develop optimal anemia treatment strategies for L/MM patients.

Fig. 1

Population flowchart for lymphoma/myeloma ECAS subgroup analysis. L, lymphoma; NHL, non-Hodgkin's lymphoma; HD, Hodgkin's disease; MM, multiple myeloma; TX, treatment.

Fig. 2

Correlation between World Health Organization (WHO) performance score at enrollment and mean hemoglobin (Hb) levels (Spearman r = −0.306; P < 0.001).

Fig. 3

Frequency of anemia during ECAS by diagnosis.

Fig. 4

Anemia according to age in patients anemic at any time during ECAS.

Fig. 5

Nadir hemoglobin (category) for patients anemic at any time during the European Cancer Anemia Survey (ECAS), including time of enrollment. Values are provided for the total L/MM population and patients categorized by diagnosis.

Fig. 6

Anemia incidence according to age.

Fig. 7

Anemia treatment according to disease status.