***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Chronic anemia of cancer can be corrected in approximately 50 % of the cases by treatment with recombinant human erythropoietin ( rHuEPO ) . Early prediction of responsiveness would avoid the emotional and financial burden of ineffective medical intervention . Eighty patients with chronic anemia of cancer undergoing treatment with rHuEPO ( 150 U/kg , 3 times per week by subcutaneous injection ; after 6 weeks without response , 300 U/kg ) participated in this study . Response was defined as a gain of at least 2 g/dL hemoglobin ( Hb ) within 12 weeks . Multivariate discriminant analysis and logistic regression analysis of response were performed on routine blood tests ; serum levels of EPO , iron , ferritin , transferrin , and its receptor ; World Health Organization ( WHO ) performance status ; various cytokines ; neopterin ; stem cell factor ; C-reactive protein ; and alpha 1-antitrypsin . At baseline , none of these factors showed sufficient prognostic power . The following predictive algorithm was developed : ( 1 ) If after 2 weeks of therapy both the serum EPO level is > or = 100 mU/mL and Hb concentration has not increased by at least 0.5 g/dL , unresponsiveness of the patient is very likely ( predictive power , 93 % ) ; otherwise , response may be predicted with an accuracy of 80 % . ( 2 ) If both the serum level of EPO is less than 100 mU/mL and Hb concentration has increased by > or = 0.5 g/dL , response is highly probable ( predictive power , 95 % ) . ( 3 ) Alternatively , a serum ferritin level of > or = 400 ng/mL after 2 weeks of rHuEPO therapy strongly indicates unresponsiveness ( predictive power , 88 % ) , whereas a level less than 400 ng/mL suggests response in 3 of 4 patients Anemia result ing from cancer or its treatment is an important clinical problem increasingly treated with the recombinant hematopoietic growth factor erythropoietin . To address uncertainties regarding indications and efficacy , the American Society of Clinical Oncology and the American Society of Hematology developed an evidence -based clinical practice guideline for the use of epoetin in patients with cancer . The guideline panel found good evidence to recommend use of epoetin as a treatment option for patients with chemotherapy-associated anemia with a hemoglobin ( Hgb ) concentration below 10 g/dL. Use of epoetin for patients with less severe anemia ( Hgb level below 12 g/dL but never below 10 g/dL ) should be determined by clinical circumstances . Good evidence from clinical trials supports the use of subcutaneous epoetin thrice weekly ( 150 U/kg ) for a minimum of 4 weeks . Less strong evidence supports an alternative weekly ( 40 000 U/wk ) dosing regimen , based on common clinical practice . With either administration schedule , dose escalation should be considered for those not responding to the initial dose . In the absence of response , continuing epoetin beyond 6 - 8 weeks does not appear to be beneficial . Epoetin should be titrated once the hemoglobin concentration reaches 12 g/dL. Evidence from one r and omized controlled trial supports use of epoetin for patients with anemia associated with low-risk myelodysplasia not receiving chemotherapy ; however , there are no published high- quality studies to support its use for anemia in other hematologic malignancies in the absence of chemotherapy . Therefore , for anemic patients with hematologic malignancies it is recommended that physicians initiate conventional therapy and observe hematologic response before considering use of epoetin 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 A prospect i ve Phase II trial was carried out to evaluate the effectiveness of erythropoietin in improving or maintaining performance status as determined by the Karnofsky performance status ( KPS ) score and hemoglobin ( Hb ) levels in lung cancer patients treated with concurrent chemoradiation ( CH-RT ) .  METHODS AND MATERIAL S A total of 51 patients with lung cancer ( 11 with small-cell , limited stage and 40 with non-small-cell disease , 17 with Stage IIIA and 23 with Stage IIIB ) , who underwent three different concurrent CH-RT protocol s were enrolled .  Baseline Hb and KPS values were recorded , as were the nadir Hb and KPS values before concurrent CH-RT . The final Hb and KPS values were recorded the last week of concurrent CH-RT . An Hb level of < or=11 g/dL before concurrent CH-RT was required before receiving erythropoietin . Prognostic factors for KPS improvement and survival were assessed by univariate and multivariate studies . RESULTS Of the 51 patients , 47 ( 92.3 % ) were men ( mean age 63.6 years , range 40 - 75 ) . The median baseline KPS score was 80 , and the mean baseline Hb was 12.2 + /- 1.76 g/dL ( range 9 - 16.9 ) . The mean nadir and final Hb value was 9.98 + /- 0.67 g/dL ( range 8.6 - 11 ) and 11.33 + /- 1.59 g/dL ( range 6.9 - 14.4 ) , respectively . A significant increase was seen in the Hb and KPS score ( p < 0.05 ) in the final measurements . Differences were found between the final and nadir Hb in the predictive value for differences in performance status ( p = 0.001 ) . On univariate study , pathologic findings ( p = 0.0234 ) , weight loss ( p = 0.0049 ) , baseline Hb ( p = 0.0057 ) , and final Hb improvement ( p = 0.0237 ) were prognostic factors for survival . Nadir Hb ( p = 0.027 ) , final Hb improvement ( p = 0.0069 ) , pathologic findings ( p = 0.0006 ) , and weight loss ( p = 0.0001 ) had significant prognostic value for survival in multivariate analysis . CONCLUSION In this study , erythropoietin appears to have a significant , beneficial impact on the KPS and Hb of patients undergoing concurrent CH-RT BACKGROUND Epoetin alfa , administered at st and ard dosages of 10,000 - 20,000 IU three times weekly or 40,000 - 60,000 IU once weekly , has been shown to significantly increase hemoglobin ( Hb ) levels , decrease transfusion requirements , and improve quality -of-life parameters in patients undergoing chemotherapy . Objective . This open-label , nonr and omized , historically controlled study was conducted to evaluate the efficacy and safety of an induction dose of epoetin alfa in patients with moderate or severe anemia who were receiving chemotherapy . METHODS Nineteen patients with solid tumors and Hb levels < 9.0 g/dl were enrolled . The patients received single s.c . injections of epoetin alfa , 40,000 IU , on study days 1 , 4 , 7 , 10 , and 13 , and were then observed for the following 30 days . Nineteen other cancer patients who had matching characteristics and had received epoetin alfa , 10,000 IU , three times weekly for the 45-day study period , served as historical controls . The primary efficacy variable was change in Hb level from baseline to days 15 ( approximately week 2 ) and 45 ( approximately week 6.5 ) . Secondary efficacy variables included the percent response ( Hb increase > or = 1 g/dl ) and percent major response ( Hb increase > or = 2 g/dl ) at days 15 and 45 , the duration s of response and major response after day 45 , the proportion of patients transfused within the 45 study days , the changes in Eastern Cooperative Oncology Group performance status score at days 15 and 45 , and the ability to maintain the planned chemotherapy dose ( dose intensity ) over the 45-day study . RESULTS Mean increases in Hb level in the epoetin alfa 40,000 IU group were significantly greater than those in the historical control group both at day 15 and at day 45 . The increase in Hb level in the control group approximated increases reported with st and ard 3-times-weekly epoetin alfa at day 15 but was somewhat lower than the increases typically seen by day 45 , presumably due to the fact that , in the present study , the epoetin alfa dose was not doubled in initial nonresponders , as is commonly done with st and ard epoetin alfa treatment . The rates of major response for epoetin alfa 40,000 IU patients ( 37 % at day 15 and 84 % at day 45 ) were higher than those for control patients ( 16 % and 21 % , respectively ) . Also , the transfusion rate was lower and performance status scores were better in the epoetin alfa 40,000 IU patients than in the control patients . In all , 74 % of epoetin alfa 40,000 IU patients versus 47 % of control patients received 100 % of the planned chemotherapy dose . Epoetin alfa was well tolerated in both treatment groups . CONCLUSIONS Results of this study suggest that epoetin alfa at a dose of 40,000 IU administered five times over 2 weeks may confer even higher response rates than those seen with st and ard dosing regimens . These encouraging results support further study of the proposed induction dose of epoetin alfa in a larger , r and omized , prospect ively controlled trial 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 in the historical experience with the three-times-weekly dosage schedule PURPOSE Epoetin alfa administered s.c . three times weekly or once weekly increases hemoglobin ( Hb ) levels , decreases transfusion requirements , and improves quality of life 
    Output:
    
Studies aim ed at correcting anaemia in cancer patients had indicated a possible survival advantage of those patients receiving erythropoietin .
This might grossly be attributed to a higher risk of thrombosis in these patients .
The largest systematic review on the use of erythropoietin in cancer patients undergoing treatment indicates a suggestive but not significant survival advantage of erythropoietin-treated patients .