title: Recombinant human erythropoietin is associated with increased overall survival in patients with multiple myeloma.
abstract: BACKGROUND
  Recombinant human erythropoietin (rhEPO) is effective for the treatment of anemia associated with multiple myeloma. Data from animal studies and case reports suggest that rhEPO has antineoplastic properties.
  
  
  METHODS
  Two hundred and ninety-two patients enrolled on different chemotherapy clinical trials at the Cleveland Clinic Myeloma Program between 1997 and 2003 were the subjects of this study. Information on erythropoietin use as well as baseline prognostic variables were collected retrospectively.
  
  
  RESULTS
  The population consisted of 257 patients with multiple myeloma treated at the Cleveland Clinic Foundation from 1997 to 2003 and followed for at least 1 month. Thirty-five patients were excluded from this analysis because information on erythropoietin use was not available. One hundred and twenty-seven patients received rhEPO for at least 1 month and the rest did not received rhEPO. On average, patients who received rhEPO were older, had a higher Southwest Oncology Group (SWOG) stage, higher serum creatinine, lower serum hemoglobin, higher beta2-microglobulin, lower platelet counts, and a longer time from diagnosis to enrollment at the myeloma program (p < 0.001 for all). After adjusting for age, months from diagnosis to enrollment, serum creatinine, hemoglobin, platelet count, and beta2-microglobulin, the use of rhEPO was associated with improved overall survival (hazard ratio = 0.6; 95% CI = 0.38-0.94) in patients with SWOG stages II, III and IV but not in patients with SWOG stage I.
  
  
  CONCLUSIONS
  rhEPO was associated with improved overall survival in this population of anemic multiple myeloma patients with SWOG stages of II, III and IV. A prospective randomized trial is warranted to corroborate this finding.
authors.affiliation: Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: R
authors.initials: R
authors.lastname: Baz
authors.forename: E
authors.initials: E
authors.lastname: Walker
authors.forename: T K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: R
authors.initials: R
authors.lastname: Abou Jawde
authors.forename: C
authors.initials: C
authors.lastname: Brand
authors.forename: B
authors.initials: B
authors.lastname: McGowan
authors.forename: E
authors.initials: E
authors.lastname: Yiannaki
authors.forename: S
authors.initials: S
authors.lastname: Andresen
authors.forename: M A
authors.initials: MA
authors.lastname: Hussein
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000401:mortality*; D011994:Recombinant Proteins; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin