Anaemia and thrombocytopenia in patients with prostate cancer and bone metastases

Abstract

Background: The purpose of this study was to determine the incidence, risk factors and prognostic impact of anaemia and thrombocytopenia in patients with bone metastases (BM) from prostate cancer.

Methods: Retrospective cohort study including 51 consecutive patients treated at a community hospital. Twenty-nine patients (57%) received taxotere after diagnosis of BM.

Results: Haemoglobin (Hb) < or = 12.0 g/dL at BM detection was associated with shorter overall survival. During follow-up, 25 patients (49%) experienced episodes with Hb < 10 g/dL unrelated to side effects of cancer therapy. Fifteen patients required red blood cell transfusion. Median time from diagnosis of BM to Hb < 10 g/dL was 23 months. Median survival from Hb < 10 g/dL was 5.4 months. There was no factor predicting for Hb < 10 g/dL. Five patients (10%) developed thrombocyte (Trc) count <50 x 10(9)/L. All of these had previously received blood transfusion. Median interval from Hb < 10 g/dL to Trc < 50 x 10(9)/L was 2.5 months. Survival after thrombocytopenia was short (3 weeks to 4 months). Haematuria and subdural haematoma were among the causes of death.

Conclusions: We found high rates of significant bone marrow failure in treatment-refractory patients. Both Hb < 10 g/dL and Trc < 50 x 10(9)/L predict for unfavourable survival.

Figure 1

Kaplan-Meier estimates of overall survival in 20 patients with bone metastases from prostate cancer, which were present at first cancer diagnosis, versus 31 patients who developed metachronous bone metastases during the course of disease, p = 0.6.

Figure 2

Kaplan-Meier estimates of time to haemoglobin <10 g/dL in 20 patients with bone metastases from prostate cancer, which were present at first cancer diagnosis, versus 31 patients who developed metachronous bone metastases during the course of disease, p = 0.4.

Figure 3

Kaplan-Meier estimate of overall survival after detection of haemoglobin <10 g/dL in 25 patients.

Figure 4

Kaplan-Meier estimates of overall survival from first diagnosis of bone metastases in 25 patients who developed haemoglobin <10 g/dL during follow-up versus 26 patients who maintained higher haemoglobin levels, p = 0.01.