Comparative outcomes of red blood cell transfusion versus erythropoiesis-stimulating agents in lung cancer patients with chemotherapy-induced anemia: A real-world analysis.

e20781 Background: Chemotherapy-induced anemia affects up to 80% of lung cancer patients and is associated with significant morbidity, yet real-world comparative outcomes of red blood cell transfusion versus erythropoiesis-stimulating agents (ESAs) as mutually exclusive options remain poorly characterized. The study objective was to explore primary end point of all-cause mortality as well as secondary end point of cardiopulmonary and neurological outcomes. Methods: In this multi-centre retrospective study using TriNetX, adults (≥18 years) with lung cancer and chemotherapy-induced anemia were identified via ICD codes. Participants were stratified by receipt of RBC transfusion or ESA therapy (epoetin alfa, darbepoetin alfa, or methoxy polyethylene glycol-epoetin beta). Participants receiving both RBC transfusion and ESA therapy were excluded to ensure mutually exclusive exposure groups. Propensity score matching adjusted for demographics, comorbidities, cancer stage, chemotherapy regimens, and hemoglobin level. Generalized linear models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Results: Before matching, 4,171 patients were identified. After propensity score matching, 1,972 participants (986 per cohort) had similar baseline characteristics (mean age of 73, 52% female; 73% White, 12% Black, 5% Asian). No significant difference in all-cause mortality was observed between cohorts [0.993 (0.827-1.191)]. ESA therapy was associated with a lower risk of sepsis [OR: 0.760 (0.579–0.996)] and myocardial infarction [OR: 0.648 (0.423–0.991)], but higher incidence of brain metastases [OR: 1.408 (1.054-1.881)] compared with RBC transfusion. No significant difference was observed for deep vein thrombosis or pulmonary embolism. Conclusions: In this real-world analysis, ESA therapy was associated with lower risks of sepsis and myocardial infarction, but a higher incidence of brain metastases, potentially due to erythropoietin receptor-mediated tumor progression. These findings may inform individualized risk-benefit discussions when selecting anemia management strategies in lung cancer. Prospective studies are needed to validate these associations.