title: Anemia in diffuse large B-cell non-Hodgkin lymphoma: the role of interleukin-6, hepcidin and erythropoietin.
abstract: Anemia is a frequent sign in patients with diffuse large B-cell lymphoma (DLBCL) at diagnosis. We determined erythropoietin, hepcidin and interleukin-6 (IL-6) in plasma samples of 53 patients with DLBCL. The majority of patients (40/53, 75%) showed defective endogenous erythropoietin production, in particular when anemia was present (p = 0.01). Hepcidin plasma levels were significantly higher in patients compared to controls (p = 0.006), particularly in those with characteristics associated with a more active disease, including elevated lactate dehydrogenase (LDH) (p = 0.0004), B-symptoms (p = 0.07) and an age-adjusted international prognostic index (IPI) score > 1 (p = 0.01). Hepcidin levels correlated strongly to ferritin (r = 0.77, p < 0.0001) and weakly to IL-6 concentrations (r = 0.30, p = 0.03), but not to hemoglobin values. IL-6 inversely correlated to hemoglobin values in both univariate and multivariate analysis (p = 0.04), including hepcidin and erythropoietin as variables. Our findings suggest that elevated hepcidin levels and inadequate erythropoietin response are frequent in DLBCL, but elevated IL-6 plays the major role for the development of anemia.
authors: Institute of Hematology Institute of Pathological Anatomy, Catholic University S. Cuore , Rome , Italy.
authors: Maria Chiara
authors: MC
authors: Tisi
authors: Valentina
authors: V
authors: Bozzoli
authors: Manuela
authors: M
authors: Giachelia
authors: Giuseppina
authors: G
authors: Massini
authors: Bianca Maria
authors: BM
authors: Ricerca
authors: Elena
authors: E
authors: Maiolo
authors: Francesco
authors: F
authors: D'Alo'
authors: Luigi Maria
authors: LM
authors: Larocca
authors: Alfonso
authors: A
authors: Piciocchi
authors: Harold
authors: H
authors: Tjalsma
authors: Dorine W
authors: DW
authors: Swinkels
authors: Maria Teresa
authors: MT
authors: Voso
authors: Giuseppe
authors: G
authors: Leone
authors: Stefan
authors: S
authors: Hohaus
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood* / Q000150:complications; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D005293:Ferritins / Q000097:blood; D064451:Hepcidins / Q000097:blood*; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods; D015850:Interleukin-6 / Q000097:blood*; D016015:Logistic Models; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D055815:Young Adult
chemical_list: D064451:Hepcidins; D015850:Interleukin-6; D004921:Erythropoietin; D005293:Ferritins