***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Anemia is a frequent and potentially serious toxicity associated with the use of carboplatin , particularly when this agent is administered in the salvage setting . In an effort to evaluate a possible role for human erythropoietin ( rh-E ) in preventing or minimizing carboplatin-induced anemia we analyzed the impact of the agent on anemia and transfusion requirements of women with ovarian cancer who were treated on one of two nonr and omized trials employing identical second-line carboplatin-based intraperitoneal regimens , with the only difference in the regimens being the addition of rh-E ( Study 1 , without rh-E ; Study 2 , with rh-E ) . There was a statistically significant difference in the incidence of documented nadir hemoglobin levels of < 9 g/dl ( Study 1 , 60 % ; Study 2 , 13 % ; P < 0.005 ) and < 8 g/dl ( Study 1 , 33 % ; Study 3 , 6 % ; P < 0.05 ) . We also observed a threefold reduction in transfusion requirements with the use of rh-E ( Study 1 , 23 % ; Study 2 , 6 % ) , but this difference was not statistically significant with the limited sample size evaluated . In this nonr and omized comparison of two identical chemotherapy programs we have demonstrated that rh-E significantly reduced the incidence and severity of anemia associated with carboplatin-based chemotherapy . A r and omized trial examining the potential impact of rh-E on carboplatin-induced anemia and transfusion requirements is warranted The purpose of this study was to determine the safety , efficacy and impact on quality of life of recombinant human erythropoietin ( r-HuEPO ) for cancer patients undergoing radiotherapy ( RT ) . An open-labelled r and omized design was used , with patients r and omized to either treatment or control arms . Patients in the treatment arm received r-HuEPO given by subcutaneous injection at a dose of 200 units kg(-1 ) day(-1 ) plus oral iron supplements ( ferrous sulphate 325 mg p.o . t.i.d . ) . Entry was restricted to patients with carcinoma of the lung , uterine cervix , prostate or breast who presented for RT with anaemia parameters reflective of ' the anaemia of chronic disease ' . Radiotherapy policies ( portals , doses , fraction size , etc . ) were determined by the site and stage of disease . Complete blood counts ( CBCs ) were obtained weekly . The target level of haemoglobin was 15 g dl(-1 ) for men and 14 g dl(-1 ) for women . Quality of life ( QOL ) was assessed weekly by using an analogue scale to judge energy , activities of daily living and overall quality of life .  Forty-eight patients were entered in the study , 24 in the treatment arm and 24 in the control arm . The prer and omization demographic characteristics and mean laboratory values were comparable in both arms . The mean haemoglobin at completion was 13.6 g dl(-1 ) for r-HuEPO-treated patients compared with 11.0 g dl(-1 ) for control subjects ( P = 0.0012 ) . Patients who received r-HuEPO demonstrated a mean weekly haemoglobin increase of 0.41 g dl(-1 ) compared with a decrease in mean haemoglobin level in controls for 6 of the 7 weeks of the study ( mean weekly decrease of 0.073 g dl(-1 ) ) . Target levels of haemoglobin were achieved by 41.6 % of r-HuEPO-treated patients compared with none of the control subjects . The mean platelet count declined in both arms of the study with RT but the decline from pretreatment was less rapid in r-HuEPO-treated patients ( 11.2 % decrease ) compared with controls ( 26.3 % decrease ) and was statistically significant during weeks 4 - 6 . Toxicity was minor with only mild irritation at the injection site . Mean quality of life end points were superior in the treatment arm but not statistically significant . r-HuEPO had a beneficial effect on weekly haemoglobin levels in patients undergoing RT with response rates similar to other studies . There was also a less rapid decline in weekly platelet counts in r-HuEPO-treated patients compared with control subjects . Further studies are needed to address the optimum dose and scheduling as well as the impact of r-HuEPO on clinical outcomes Previous phase I-II clinical trials have shown that recombinant human erythropoietin ( rHuEpo ) can ameliorate anemia in a portion of patients with multiple myeloma ( MM ) and non-Hodgkin 's lymphoma ( NHL ) . Therefore , we performed a r and omized controlled multicenter study to define the optimal initial dosage and to identify predictors of response to rHuEpo .  A total of 146 patients who had hemoglobin ( Hb ) levels < or = 11 g/dL and who had no need for transfusion at the time of enrollment entered this trial . Patients were r and omized to receive 1,000 U ( n = 31 ) , 2,000 U ( n = 29 ) , 5,000 U ( n = 31 ) , or 10,000 U ( n = 26 ) of rHuEpo daily subcutaneously for 8 weeks or to receive no therapy ( n = 29 ) . Of the patients , 84 suffered from MM and 62 from low- to intermediate- grade NHL , including chronic lymphocytic leukemia ; 116 of 146 ( 79 % ) received chemotherapy during the study . The mean baseline Hb level was 9.4 + /- 1.0 g/dL. The median serum Epo level was 32 mU/mL , and endogenous Epo production was found to be defective in 77 % of the patients , as judged by a value for the ratio of observed-to-predicted serum Epo levels ( O/P ratio ) of < or = 0.9 . An intention-to-treat analysis was performed to evaluate treatment efficacy . The median average increase in Hb levels per week was 0.04 g/dL in the control group and -0.04 ( P = .57 ) , 0.22 ( P = .05 ) , 0.43 ( P = .01 ) , and 0.58 ( P = .0001 ) g/dL in the 1,000 U , 2,000 U , 5,000 U , and 10,000 U groups , respectively ( P values versus control ) . The probability of response ( delta Hb > or = 2 g/dL ) increased steadily and , after 8 weeks , reached 31 % ( 2,000 U ) , 61 % ( 5,000 U ) , and 62 % ( 10,000 U ) , respectively . Regression analysis using Cox 's proportional hazard model and classification and regression tree analysis showed that serum Epo levels and the O/P ratio were the most important factors predicting response in patients receiving 5,000 or 10,000 U. Approximately three quarters of patients presenting with Epo levels inappropriately low for the degree of anemia responded to rHuEpo , whereas only one quarter of those with adequate Epo levels did so . Classification and regression tree analysis also showed that doses of 2,000 U daily were effective in patients with an average platelet count greater than 150 x 10(9)/L. About 50 % of these patients are expected to respond to rHuEpo . Thus , rHuEpo was safe and effective in ameliorating the anemia of MM and NHL patients who showed defective endogenous Epo production . From a practical point of view , we conclude that the decision to use rHuEpo in an individual anemic patient with MM or NHL should be based on serum Epo levels , whereas the choice of the initial dosage should be based on residual marrow function BACKGROUND Patients undergoing chemotherapy for treatment of malignancy frequently experience clinical ly significant anemia . Myelosuppressive chemotherapy impairs erythropoiesis , which may not fully recover between treatment cycles . Recombinant human erythropoietin ( rHuEPO ) has been effectively introduced in anemic patients suffering from chronic renal failure . The present study was design ed to assess , first , whether rHuEPO treatment decreases transfusion requirements in chemotherapy-induced anemia and , second , whether high-dose rHuEPO application is safe . STUDY DESIGN AND METHODS Thirty consecutive anemic patients ( hemoglobin < 11 g/dl ) receiving combination chemotherapy for primary malignant bone tumors were studied in a prospect i ve , double-blind , r and omized , Phase III trial . Patients received chemotherapy according to one of two German protocol s , depending on histologic diagnosis . All subjects enrolled were r and omly assigned either to receive 600 IU of rHuEPO per kg of body weight intravenously twice a week or to receive a placebo during chemotherapy . To obtain comparable data , an observation period of 20 weeks was chosen . Twenty-nine patients fulfilled the criteria and were eligible for statistical evaluation . RESULTS Transfusion requirements were significantly decreased from Week 8 of therapy ( p<0.05 ) in the treatment group . Therapeutic benefits were even more evident with continuation of therapy ( Week 12 , p = 0.03 ; Week 16 , p = 0.016 ; Week 20 , p = 0.002 ) . The blood required was 2.1 units of red cells in the treatment group and 8.4 units of red cells in the placebo group . All patients tolerated  rHuEPO with no serious side effects . CONCLUSION These findings suggest that rHuEPO is an effective and well-tolerated therapeutic option for decreasing the transfusion requirements in chemotherapy-induced anemia Summary Anaemia commonly occurs in cancer patients receiving chemotherapy , often necessitating blood transfusion . This multicentre study was design ed to evaluate the efficacy and safety of epoetin α in preventing the decline in haemoglobin ( Hb ) level , and to determine whether the transfusion requirement could be reduced , in patients receiving 4–6 cycles of primarily platinum-based combination cyclic chemotherapy for small cell lung cancer ( SCLC ) . A total of 130 non-anaemic SCLC patients were r and omized to receive no additional treatment ( n = 44 ) , epoetin α 150 IU kg–1 subcutaneously ( s.c . ) three times a week ( n = 42 ) or 300 IU kg–1 s.c . three times a week ( n = 44 ) . Reductions in epoetin α dosage were made during the study if Hb level increased to > 15 g dl–1 . The mean weekly dosage was 335 and 612 IU kg–1 , respectively , in the two active treatment groups . Significantly fewer ( P < 0.05 ) epoetin α-treated patients experienced anaemia ( Hb < 10 g dl–1 ) during the course of chemotherapy ( 300 IU kg–1 , 39 % ; 150 IU kg–1 , 48 % ; untreated , 66 % ) . This was reflected in the significantly lower number of treated patients transfused [ 300 IU kg–1 , 20 % ( P < 0.001 ) ; 150 IU kg–1 , 45 % ( P < 0.05 ) ; untreated , 59 % ] . Epoetin α was well-tolerated , and there was no evidence of sustained , clinical ly significant , hypertension . In summary , epoetin α is effective and well-tolerated in maintaining Hb level and reducing transfusion requirement in patients undergoing cyclic chemotherapy for SCLC PURPOSE To prospect ively evaluate the effectiveness , safety , and clinical benefits of once-weekly epoetin alfa therapy as an adjunct to chemotherapy in anemic cancer patients . PATIENTS AND METHODS A total of 3,012 patients with nonmyeloid malignancies who received chemotherapy were enrolled onto this multicenter , open-label , nonr and omized study conducted in 600 United States community-based practice s. Patients received epoetin alfa 40,000 U once weekly , which could be increased to 60,000 U once weekly after 4 weeks dependent on hemoglobin response . Treatment was continued for a maximum of 16 weeks . RESULTS Among the 2,964 patients assessable for efficacy  , epoetin alfa therapy result ed in significant increases in hemoglobin levels , decreases in transfusion requirements , and improvements in functional status and fatigue as assessed by the linear analog scale assessment ( energy level , ability to perform daily activities , and overall quality of life ) and the anemia subscale of the Functional Assessment of Cancer Therapy-Anemia question naire . Improvements in quality -of-life parameters correlated significantly ( P < .001 ) with increased hemoglobin levels . The direct relationship between hemoglobin and quality -of-life improvement was sustained during the 16-week study period , which is similar to findings of large community-based trials of three-times-weekly dosing . Once-weekly epoetin alfa was well tolerated , with most adverse events attributed to the underlying disease or concomitant chemotherapy . CONCLUSION The results from this large , prospect i ve , community-based trial suggest that once-weekly epoetin alfa therapy increases hemoglobin levels , decreases transfusion requirements , and improves quality of life in patients with cancer and anemia who undergo concomitant chemotherapy . Based on the results of this study , the clinical benefits and the adverse event profile of once-weekly epoetin alfa therapy in community-based practice are similar to those observed 
    Output:
    
For treatment-related anemia , meta- analysis of available evidence ( 22 trials ; N = 1,927 ) demonstrated reduced odds of transfusion after erythropoietin , but higher- quality trials reported smaller odds reductions .
For those undergoing allotransplants , evidence ( 7 trials ; N = 493 ) showed erythropoietin modestly decreased time to red cell engraftment and transfusions .
Studies on erythropoietin after autologous transplants ( 6 trials ; N = 321 ) did not support a beneficial effect of erythropoietin