Anemia in hematological and solid tumors: pathogenesis, clinical manifestations, correction methods

Anemia in patients with malignancies is a common disorder that has a markedly negative impact on quality of life and overall prognosis. The pathogenesis of anemia is complex and multifactorial, depending on the type and stage of malignancy, nutritional status, renal function, age and gender, cytostatic drug, dose, and chemotherapeutic regimen, with iron deficiency often being the main and potentially treatable factor for anemia. In cancer patients, it can be caused by various concomitant mechanisms, including bleeding (e.g., in malignant gastrointestinal tumors or after surgery), malnutrition, medication, and hepcidin-induced iron sequestration in macrophages, with subsequent irondeficient erythropoiesis. The article presents a literature review on the mechanisms of anemia in patients with hematologic malignancies and a classification of chronic anemia and methods of its correction. The need for anemia treatment is determined by its negative impact on quality of life, as well as a negative prognostic impact on the life expectancy of cancer patients, because hypoxia of tumor tissue can be associated with resistance to chemo- and radiation therapy, the stimulation of genetic mutations and neoangiogenesis, which make it difficult to control of tumor growth. A transfusion of erythrocyte mass is used to rapidly increase the hemoglobin level in case of development of a symptomatic anemia. However, a large range of risks limit the wide use of blood transfusions. Erythropoiesis-stimulating preparats are the drugs that reduce the need for blood transfusions. It describes in detail the mechanism of action, indications and side effects of rembinant erythropoietin (rEPO). The analysis of rEPO efficacy is shown in anemia treatment in patients with various types of cancer. It presents the recommendations of ASCO/ASH, ESMO, RUSSCO for the use of rEPO in various patients categories. Treatment with erythropoietins provides a smooth and prolonged rise in the hemoglobin level, the release of fully functional red blood cells into the blood. The use of erythropoietins can significantly improve the quality of life of cancer patients without reducing the effectiveness of chemotherapy.