This study compared the effects of early intervention with standard use of epoetin alfa on haemoglobin (Hb) levels and transfusion requirements in cancer patients receiving chemotherapy. Patients with Hb>10 and < or= 12 g/dL were randomised 1:1 to epoetin alfa (40,000 IU, subcutaneously, once weekly), initiated within 7d of the start of the first on-study chemotherapy cycle (defined as early intervention) versus epoetin alfa when Hb <or= 10 g/dL (defined as standard therapy). Increases in Hb values were significantly higher with early intervention compared to standard therapy from week 6 to 10 (P <or= 0.05) and approached significance at week 15/16 (P=0.0531). Although the percentage of patients receiving blood transfusions was similar in both groups, the amount of blood transfused was almost twice as high in the standard epoetin alfa group (n.s.). Early intervention with epoetin alfa was well tolerated and overall survival did not differ significantly between groups. Initiation of epoetin alfa at the onset of chemotherapy and Hb<12 g/dL improves Hb levels significantly versus standard therapy.