Erythropoietin therapy after allogeneic hematopoietic cell transplantation: a prospective, randomized trial.
We conducted a prospective randomized trial to assess hemoglobin (Hb) response to recombinant human erythropoietin (rhEPO) therapy after hematopoietic cell transplantation (HCT). Patients (N = 131) were randomized (1:1) between no treatment (control arm) or erythropoietin at 500 U/kg per week (EPO arm). Patients were also stratified into 3 cohorts: patients undergoing myeloablative HCT with rhEPO to start on day (D)28, patients given nonmyeloablative HCT (NMHCT) with rhEPO to start on D28, and patients also given NMHCT but with rhEPO to start on D0. The proportion of complete correctors (ie, Hb ≥13 g/dL) before D126 posttransplant was 8.1% in the control arm (median not reached) and 63.1% in the EPO arm (median, 90 days) (P < .001). Hb levels were higher and transfusion requirements decreased (P < .001) in the EPO arm, but not during the first month in the nonmyeloablative cohort starting rhEPO on D0. There was no difference in rates of thromboembolic events or other complications between the 2 arms. This is the first randomized trial to demonstrate that rhEPO therapy hastens erythroid recovery and decreases transfusion requirements when started one month after allogeneic HCT. There was no benefit to start rhEPO earlier after NMHCT.
Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire of Liège and University of Liège, Liège, Belgium;
Aurélie
A
Jaspers
Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire of Liège and University of Liège, Liège, Belgium;
Frédéric
F
Baron
Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire of Liège and University of Liège, Liège, Belgium;
Evelyne
E
Willems
Department of Statistics, University of Liège, Liège, Belgium; and.
Laurence
L
Seidel
Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire of Liège and University of Liège, Liège, Belgium;
Kaoutar
K
Hafraoui
Department of Medicine, Division of Hematology-Oncology, Centre Hospitalier Peltzer-La Tourelle, Verviers, Belgium.
Gaetan
G
Vanstraelen
Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire of Liège and University of Liège, Liège, Belgium;
Christophe
C
Bonnet
Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire of Liège and University of Liège, Liège, Belgium;
Yves
Y
Beguin
D000328:Adult; D064591:Allografts; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006400:Hematocrit; D018380:Hematopoietic Stem Cell Transplantation; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D014184:Transplantation, Homologous
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin