Population-based analysis of the frequency of anemia and its management before and during chemotherapy in patients with malignant lymphoma.

Objective: In patients with hematologic malignancies, chemotherapy can further suppress bone marrow production. Whereas measures to correct anemia can improve patients' function and quality of life, the intervention threshold and the methods of correcting anemia in patients with malignant lymphoma are not clear. This study evaluates the frequency of anemia and the interventions used to correct anemia before and during chemotherapy for patients with Hodgkin and non-Hodgkin lymphomas.

Methods: A retrospective electronic chart review was conducted of 312 patients who received cytotoxic chemotherapy for malignant lymphoma at 4 British Columbia Cancer Agency centers from June 1, 2004 to May 1, 2006. The chemotherapy regimens delivered were: doxorubicin, cyclophosphamide, vincristine, and prednisone (CHOP) in 24 patients, CHOP + Rituximab (CHOP-R) in 215 patients, and Adriamycin, bleomycin, vinblastine, dacarbazine in 73 patients. Initial hemoglobin (Hgb) and dates of lowest Hgb in the ranges, 110 to 119, 100 to 109, 90 to 99, 80 to 89, and <80 g/L were recorded. Review of medical records was performed to document the frequency of symptoms that may be related to anemia and the frequency of any discussion or intervention for anemia such as transfusion or erythropoietin (Epo).

Results: The median age was 57 years (range, 16-87 years). About 24% of patients had Hodgkin's and 76% had non-Hodgkin's lymphoma. Prior to starting chemotherapy, 34% of subjects had an Hgb <120 g/L and 11% of subjects had an Hgb <100 g/L. In all patients with Hgb <120 g/L prechemotherapy, symptoms of anemia were documented in 57% but intervention to correct anemia occurred in only 4% of patients. During chemotherapy, 42% of subjects had a Hgb <120 g/L and 12% had a Hgb <100 g/L. Discussion and intervention rates increased with declining Hgb, particularly at levels <100 g/L. Among 36 patients with Hgb <100 g/L, symptoms were documented in 31 patients. Transfusion was used in 24 patients and Epo in 2 patients. During chemotherapy, 63% of patients with Hgb <120 g/L were symptomatic, but only 20% received an intervention to correct anemia.

Conclusion: Anemia was common prior to and during chemotherapy in patients with malignant lymphoma. The threshold of anemia intervention varied, with transfusion being the predominant method used. The rates of intervention for anemia were low in patients with anemia, despite randomized trials showing that anemia correction can improve fatigue and quality of life.