Chemotherapy anaemia

Neorecormon (tradename, also known as epoetin beta) is a recombinant human EPO first approved for medical use in the EU in 1997. It is indicated for the treatment of anaemia associated with various medical conditions, most commonly chronic renal failure and cancer patients receiving chemotherapy. Neorecormon is produced by recombinant DNA technology in a CHO cell line and is manufactured as outlined in Figure 10.5. It is presented in lyophilized format at various strengths (500-10 000 IU/vial) and contains phosphate buffer, sodium chloride, calcium chloride, urea, polysorbate and various amino acids as excipients. 

Treatment of anaemia associated with chronic disease Treatment of anaemia associated with cancer/chemotherapy Treatment of anaemia associated with prematurity To facilitate autologous blood donations before surgery To reduce transfusion requirements after surgery To prevent anaemia after bone marrow transplantation... 

Arsenic is highly toxic, and indeed much speculation has surrounded arsenic poisoning as the cause of death of Napoleon Bonaparte, on account of the levels of As in the Emperor s hair (perhaps derived from fungal activity on a green pigment present in the wallpaper of his apartments in St. Helena). Arsenic trioxide has been approved by the Food and Drug Administration (FDA) of the USA for the treatment of acute promyelocytic anaemia in adult patients who fail to respond to other chemotherapy, or have relapsed disease. 

Erythropoeitins are used to treat symptomatic anaemia associated with erythropoietin deficiency in chronic renal failure and to shorten the period of symptomatic anaemia in patients receiving cytotoxic chemotherapy. It is not recommended for use in cancer patients who are not receiving chemotherapy. In cancer patients, the risk of thrombosis and related complications might be increased. The haemoglobin concentration should be maintained within the range of 10-12 g/100 ml - higher concentrations should be avoided to reduce risk of complications of therapy. 

It is used in the treatment of anaemia of chronic renal failure, in anaemia of patients with AIDS who are being treated with zidovudine and anaemia associated with cancer chemotherapy. 

J. Vansteenkiste, G. Rossi, and M. Foote, Darbepoetin alpha A new approach to the treatment of chemotherapy-induced anaemia, Expert Opin. Biol. Ther., 3 (2003) 501-508. 

In anaemia of chronic disease, anaemia associated with chemotherapy or anaemia associated with renal disease, recombinant erythropoietin can stimulate red cell production. 

Another major use of G-CSF is for patients with neutropenia as a result of cytotoxic chemotherapy, to shorten the duration of neutropenia and reduce morbidity due to infection. It is also used for the same purpose after autologous and allogeneic bone marrow transplantation, in aplastic anaemia, AIDS, and congenital, cyclical and idiopathic neutropenia. In combination with epoetin, G-CSF can be effective in the management of some patients with myelo-dysplastic syndromes. G-CSF not only improves the neutrophil count, but dramatically improves the proportion of patients with a raised haemoglobin in response to epoetin possibly by reduction of erythroid apoptosis (the cause of ineffective erythropoiesis). 

Barrett-Lee PJ, Bailey NP, O Brien ME, Wager E. Large-scale UK audit of blood transfusion requirements and anaemia in patients receivmg cytotoxic chemotherapy. Br J Cancer 2000 82(l) 93-7. 

Barosi G, Marchetti M, Liberate NL. Cost-effectiveness of recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia. Br J Cancer 1998 78(6) 781-7. 

Csaki C, Ferenez T, Schuler D, Borsi JD. Recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia in children with malignant solid tumours. Eur J Cancer 1998 34(3) 364-7. 

Epogen Procrit ) - more fully termed 1-165-erythropoetin (human clone y HEPOFL13 protein moiety -is recombinant human erythropoietin produced by genetically engineered Chinese hamster cells. It is a haematinic and regulates red blood cell production. It is used as a haemopoietic and ANTMNAEMIC in the treatment of anaemia associated with chfbnic renal failure, and also in ANTICANCER chemotherapy to stimulate erythrocyte production after treatment. 

Aranesp Darbepoetin alpha Anaemia from kidney disease or chemotherapy 3.9 4 Plavix Clopidogrel Anti-coagulant 5.8 -3.4... 

Krzakowski M. Epoetin delta efficacy in the treatment of anaemia in cancer patients receiving chemotherapy. Clin Oncol (R CoU Radiol) 2008 20(9) 705-13. 

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