Few data are available regarding the proportion of patients with hemoglobin in the range of 9 g/dL to <10 g/dL who will experience a hemoglobin decline to <9 g/dL or the rate at which the decline occurs. However, not all patients whose hemoglobin is in the 9 g/dL to 10 g/dL range will continue to fall to levels of <9 g/dL, and because ESAs have risks, the decision of when to initiate an ESA is partially informed by the rate of hemoglobin decline and the likelihood that the patient will require a transfusion if they do not receive the ESA. Studies have suggested that initiating an ESA when hemoglobin is between 9 g/dL and 10 g/dL results in fewer transfusions compared with initiating an ESA when hemoglobin is <9 g/dL. ![]() However, ESAs take time to induce a hemoglobin response and therefore are not suitable for patients who require immediate correction of anemia. According to current ESA labels, treatment with ESAs in patients receiving chemotherapy should not be considered until hemoglobin levels are less than 10 g/dL in the USA or at or below 10 g/dL in the EU. Chemotherapy-induced anemia can be treated with erythropoiesis-stimulating agents (ESAs), red blood cell (RBC) transfusions, or both. ![]() Anemia is common in cancer patients receiving chemotherapy and is associated with poor clinical outcomes.
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