Management of disease-related anemia in patients with multiple myeloma or chronic lymphocytic leukemia: epoetin treatment recommendations.
Multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) patients often develop anemia due to the disease process and effects from disease therapy. Blood transfusion, the established treatment, has an immediate effect in improving patients' hemoglobin levels. However, this effect is transient and transfusion is associated with several risks, including infections and mild to life-threatening immunologic reactions. A newer option is recombinant human erythropoietin (epoetin); a biological treatment that leads to increased hemoglobin levels over an extended time without the risks of blood transfusion. Extensive evidence has shown that epoetin is effective in the treatment of cancer-associated anemia. An international expert panel met to develop treatment recommendations for the use of epoetin in MM and CLL patients. Based on the available data, it is recommended that treatment be initiated only after other possible causes of anemia are eliminated. Epoetin should be administered to any patient with hemoglobin < or=10 g/dl. Patients with hemoglobin 10-12 g/dl should receive epoetin if they suffer from significant symptoms of anemia and/or have progressively decreasing hemoglobin values. Dosage should be initiated at 10 000 IU three times/week or 40 000 IU once/week and be titrated to maintain hemoglobin at 12 g/dl. Nonresponsive patients (<1 g/dl increase over four weeks) may have their dose increased to 20 000 IU three times/week or 60 000 IU once/week, respectively. Epoetin treatment should be discontinued if there is no response to the increased dosage, or hemoglobin >14 g/dl. Treatment should resume for patients who exceed 14 g/dl, at a reduced dosage, if their hemoglobin falls below 12 g/dl.
Department of Medicine and Medical Oncology, Wihelminenspital, Montleartstrasse 37, A-1171 Vienna, Austria. Heinz.Ludwig@lme.wil.magwien.gv.at
Heinz
H
Ludwig
Kanti
K
Rai
Joan
J
Blade
Franco
F
Dammacco
Laurent
L
Degos
Loretta
L
Itri
Robert
R
Kyle
Vicenzo
V
Liso
Timothy James
TJ
Littlewood
Franco
F
Mandelli
Giovanna
G
Meloni
Stefano
S
Molica
Anders
A
Osterborg
Gerassimos A
GA
Pangalis
Jesus
J
San Miguel
Barbara
B
Schmitt
Dimitrios
D
Voliotis
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D019468:Disease Management; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications*; D009101:Multiple Myeloma / Q000150:complications*; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa