Epoetin alfa (Procrit®)2 / 1)Treatment of anemia in patients with non-myeloid malignancies, where anemia is due to concomitantly administered chemotherapy (CIA)
Hold for Hb≥10g/dL / Ferritin≥100ng/mL, TSAT≥ 20%, Hb<10g/dL, concurrent chemotherapy within the last 8 weeks, palliative intent, and completed APPRISE acknowledgement form / 40,000 units SC weekly / Titration for CIA: See DOSING LEVEL CHART and TABLE 1
Titration for MDS: See DOSING LEVEL CHART and TABLE 2
ESA dose should not be increased more frequently than every four weeks; doses may be decreased more frequently
The provider must be contacted to approve a higher dosing schema for MDS patients that require a dose above Dose Level A / Serious allergic reaction to epoetin alfa or darbepoetin alfa
Uncontrolled hypertension
Pure red cell aplasia that begins following treatment with epoetin alfa or darbepoetin alfa
Epoetin multidose vials in infant, neonates, pregnant or nursing women, vials contain benzyl alcohol / >10% of patients: hypertension, fever, headache, pruritus, nausea/vomiting, injection site reactions, arthralgia
<10% of patients: deep vein thrombosis, edema, chills, depression, dysphagia, upper respiratory infection
<1% serious reactions: anaphylactic reactions, hypersensitivity, pure red cell aplasia, seizure, renal artery thrombosis, stroke, tumor progression / Baseline Labs: Ferritin, TSAT, Hb, and erythropoietin level (MDS patients) obtained at least 10 days prior to initiation of ESA therapy
Hb must be obtained within 72 hours prior to each ESA dose; the most current Hb value should be used for dosing
TSAT and ferritin levels should be obtained at least every 3 months
Blood pressure must be obtained prior to each ESA dose; if blood pressure is >170/110mmHg, the provider should be contacted
If the patient received a transfusion in the last seven days and
· Hb is below goal, continue dosing per the guidelines
· Hb is above goal, hold dose and follow up in approximately one week for repeat Hb labs; subsequent dosing should resume per the guidelines
Risk Evaluation and Mitigation Strategies (REMS) program is required for Procrit and Aranesp; a medication guide must be given to each patient
CIA patients must have a signed APPRISE acknowledgment form on file
2)Treatment of anemia related to MDSa
Hold for Hb≥12g/dL / Ferritin≥100ng/mL, TSAT≥ 20%, Hb<10g/dL, erythropoietin level<500mU/mL, and blasts<10%
Darbepoetin alfa (Aranesp®)3 / 1)Treatment of anemia in patients with non-myeloid malignancies, where anemia is due to concomitantly administered chemotherapy (CIA)
Hold for Hb≥10g/dL / Ferritin≥100ng/mL, TSAT≥ 20%, Hb<10g/dL, concurrent chemotherapy within the last 8 weeks, palliative intent, and completed APPRISE acknowledgement form / 500 µg SC every three weeks
2)Treatment of anemia related to MDSa
Hold for Hb≥12g/dL / Ferritin≥100ng/mL, TSAT≥ 20%, Hb<10g/dL, erythropoietin level<500mU/mL, and blasts<10%
a: Non-FDA approved indication, medically accepted indications as defined by the National Government Services and included in the CMS compendium of covered drugs
b: Dosing provided for patients 18 years or older