Recombinant Human Erythropoietin (rhEPO) in Clinical Oncology


MR Nowrousian
Published by Springer Medicine (2002)
ISBN:  3-2118-3661-6.  492 pages plus index.

This comprehensive text is an excellent resource and examines the biology of erythropoietin, causes, prevalence and management of cancer-related anaemia with rhEPO. It is well-referenced and has helpful “conclusions/summary” sections at the end of each chapter. It is well-balanced, highlighting areas where rhEPO is currently appropriate while exploring areas where further investigation is required. Unfortunately there is a lack of tables summarising the data and some of the methodological deficiencies of referenced publications are not discussed.

The initial chapters discuss the biology of endogenous erythropoietin. A basic level of erythropoietin pathophysiology is assumed with lack of discussion about mechanisms of renal responses to tissue hypoxia and how that translates to renal erythropoietin production. It would be difficult for those not familiar with the area as there is a lack of simple diagrams explaining feedback loops, yet there are numerous more advanced illustrations of cell signalling.

Subsequent chapters discuss the mechanisms of anaemia of chronic disease and cancer-related anaemia. A somewhat excessive three chapters are dedicated to radiation therapy and tumour hypoxia. The chapters dedicated to anaemia and its impact on end-organ function and fatigue are valuable and the important inter-relationship between anaemia, fatigue and quality of life (QOL) is appropriately discussed. The text provides an excellent review on the indications of rhEPO for solid tumours and haematological malignancies, although the section on myelodysplasia is a bit thin.

Unfortunately, the text is already somewhat out-of-date with a number of recent publications on QOL and rhEPO not sighted. Furthermore, outdated terms such as NESP (Novel Erythroid Stimulating Factor), rather than darbepoietin are used. This text also was published prior to recent release of the American Society of Haematology/American Society of Clinical Oncology Guidelines on erythropoietin therapy. The text also predates the report of erythropoietin antibodies and consequent pure red cell aplasia (N Engl J Med 2002; 346:469-75), which has had major ramifications as to the risks of rhEPO and route of administration. Indeed, can we continue to administer rhEPO subcutaneously in cancer patients as recommended by the text? The answer is probably yes, but it is a pity that a text such as this does not explore this issue.

Thus, this book is a useful reference text for treating oncologists, haematologists and transfusion medicine specialists, but purchase it soon before it goes any further out-of-date.

H M Prince
Dept of Haematology
Peter MacCallum Cancer Centre
Melbourne, VIC

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