Epidemiology of Chemotherapy-Induced Anemia in Patients with Non-Hodgkin Lymphoma

Abstract

Introduction: Anemia is a common adverse effect of myelosuppressive chemotherapy, and the development of chemotherapy-induced anemia (CIA) is more common in patients with hematologic malignant tumors.

Objective: To assess the incidence and treatment pattern of CIA in patients diagnosed with non-Hodgkin lymphoma (NHL) from a large managed care organization in California.

Methods: Patients diagnosed with NHL between 2010 and 2012 were studied to provide an updated picture of CIA in current hematology-oncology practice. Trends in anemia treatment patterns were examined from 2000 to 2013. All data were collected from Kaiser Permanente Southern California electronic health records.

Results: Of 699 chemotherapy-treated patients with NHL diagnosed between 2010 and 2012, 36.9% and 11.6% developed moderate (hemoglobin < 10 g/dL) and severe (hemoglobin < 8 g/dL) CIA during chemotherapy, respectively. Proportions of moderate CIA events treated with erythropoiesis-stimulating agents (ESAs) decreased from 2000 to 2013: 34% in phase 1 (January 1, 2000, to December 31, 2006), 22% in phase 2 (January 1, 2007, to March 24, 2010), and 6% in phase 3 (March 25, 2010, to June 30, 2013). An increasing trend of red blood cell transfusion was observed: 12% in phase 1, 22% in phase 2, and 27% in phase 3. Similar calendar trends were observed for management of severe CIA events.

Discussion: In contrast to previous European reports, we note a higher incidence of CIA in patients with NHL in this US community practice setting.

Conclusion: Moderate to severe CIA is common in patients with NHL receiving chemotherapy. Multiple ESA-related policy changes occurred from 2000 to 2013. A large proportion of CIA episodes were currently not treated with ESA, and transfusions have become more common. Further studies are needed to determine associations between CIA symptom burden and CIA treatment as they relate to patient outcomes and quality of life.

Figure 1

Incidence proportion of anemia by chemotherapy regimens and cycles among patients with non-Hodgkin lymphoma (NHL). CHOP = cyclophosphamide, doxorubicin, vincristine, and prednisone; Hb = hemoglobin; R-CHOP = rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.

Figure 2

Proportions of anemic episodes with erythropoiesis-stimulating agent use, red blood cell transfusion, red blood cell transfusion and erythropoiesis-stimulating agent use, use of supplements, and no treatment among all patients with non-Hodgkin lymphoma receiving chemotherapy (A and B; above) and patients with stage IV non-Hodgkin lymphoma receiving chemotherapy. Proportions of anemic episodes with erythropoiesis-stimulating agent use, red blood cell transfusion, red blood cell transfusion and erythropoiesis-stimulating agent use, use of supplements, and no treatment among all patients with non-Hodgkin lymphoma receiving chemotherapy (A and B; previous page) and patients with stage IV non-Hodgkin lymphoma receiving chemotherapy (C and D; above). ESA = erythropoiesis-stimulating agents; Hb = hemoglobin; RBC = red blood cell.

Figure 2

Proportions of anemic episodes with erythropoiesis-stimulating agent use, red blood cell transfusion, red blood cell transfusion and erythropoiesis-stimulating agent use, use of supplements, and no treatment among all patients with non-Hodgkin lymphoma receiving chemotherapy (A and B; above) and patients with stage IV non-Hodgkin lymphoma receiving chemotherapy. Proportions of anemic episodes with erythropoiesis-stimulating agent use, red blood cell transfusion, red blood cell transfusion and erythropoiesis-stimulating agent use, use of supplements, and no treatment among all patients with non-Hodgkin lymphoma receiving chemotherapy (A and B; previous page) and patients with stage IV non-Hodgkin lymphoma receiving chemotherapy (C and D; above). ESA = erythropoiesis-stimulating agents; Hb = hemoglobin; RBC = red blood cell.