Evaluation of erythroid marrow response to recombinant human erythropoietin in patients with cancer anaemia.
BACKGROUND
Anaemia is a frequent finding in patients with cancer and may be due to different causes, including blunted erythropoietin production.


METHODS
In a pilot study, we administered recombinant human erythropoietin (rHuEPO) to twelve patients with solid tumours and secondary anaemia. rHuEPO was given subcutaneously 5 d per week at escalating doses (75 to 150 U/kg per day): the aim of treatment was a Hb level > or = 10 g/dl without blood transfusion. We evaluated endogenous EPO production through serum EPO levels and erythroid marrow activity by means of serum transferrin receptor (TfR).


RESULTS
Six out of 12 subjects had defective endogenous EPO production. All patients but two responded to treatment with steady increases in Hb levels above 10 g/dl, and the median dose of rHuEPO required for correction of anaemia was 75 U/kg. Response was associated with an early increase in serum TfR. Six patients developed functional iron deficiency and required iron supplementation to obtain response. Treatment improved functional ability in 4/10 responders.


CONCLUSIONS
Subcutaneous rHuEPO can stimulate erythroid marrow activity in cancer anaemia, even in patients with advanced disease, and marrow response can be adequately monitored by serum TfR. Functional iron deficiency as a cause of nonresponse to rHuEPO is frequent in these patients and may require parenteral iron administration. Although erythropoietin can improve the anaemia of cancer, the decision to treat should be individualised for each patient, looking more at the quality of life and cost-effectiveness than at cosmetic increases in the haemoglobin level.
Ponchio
L
L
Dipartimento di Medicina Interna e Terapia Medica, IRCCS Policlinico San Matteo, Pavia, Italy.
Beguin
Y
Y
Farina
G
G
Pedrazzoli
P
P
Pedrotti
C
C
Poggi
G
G
Rosti
V
V
Bergamaschi
G
G
Battistel
V
V
Cazzola
M
M
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D015672:Erythroid Precursor Cells / Q000187:drug effects*; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D007501:Iron / Q000008:administration & dosage; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000150:complications; D010865:Pilot Projects; D011994:Recombinant Proteins / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D013268:Stimulation, Chemical
D007155:Immunologic Factors; D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron