National Comprehensive Cancer Network

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NCCN Updates Cancer- and Treatment-Related Anemia Guidelines

FORT WASHINGTON, Pa., December 20, 2007 — The National Comprehensive Cancer Network (NCCN) announces important updates to the NCCN Cancer- and Treatment-Related Anemia Guidelines relating to the use of erythropoietin-stimulating agents (ESAs), such as epoetin alfa and darbepoetin alfa.

ESAs are no longer recommended for the treatment of cancer-related anemia associated with solid tumors or hematologic malignancies other than myelodysplastic syndromes (MDS). ESA therapy is an option for patients receiving myelosuppressive chemotherapy who have symptoms of anemia and hemoglobin levels of less than 11 g/dL. ESA therapy should only be considered as an option for patients receiving myelosuppressive chemotherapy without symptoms of anemia if they have hemoglobin levels less than or equal to 10 g/dL and additional risk factors for the development of symptomatic anemia requiring transfusion. When ESAs are administered to patients with cancer receiving myelosuppressive chemotherapy, the drug dosage should be titrated to achieve hemoglobin levels in the range of 10 to <12 g/dL for the purpose of avoiding red blood cell transfusion. Use of ESAs in patients with cancer receiving myelosuppressive chemotherapy is limited to the period during chemotherapy and for a short period following chemotherapy, usually within 6 weeks following the end of such therapy. These changes reflect recent evidence indicating decreased survival in patients with cancer receiving ESA therapy and changes made to the product labels of these agents by the Food and Drug Administration (FDA).

In order to facilitate shared physician-patient decision-making for those patients with cancer at risk of anemia requiring transfusion who will undergo myelosuppressive chemotherapy, patient counseling regarding the risks and benefits of ESA therapy is recommended.

NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence by multidisciplinary panels of expert physicians from NCCN Member Institutions. The most recent version of this and all the guidelines are available free of charge at

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit

The NCCN Member Institutions are:

  • Fred & Pamela Buffett Cancer Center
  • Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
  • City of Hope Comprehensive Cancer Center
  • Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Cancer Institute
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Comprehensive Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • University of Wisconsin Carbone Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital