Anaemia is a complication reported in up to 70% of the multiple myeloma patients (MM), with remarkable clinical, cognitive and socio-relational consequences. Anaemia relates to the course of MM, normalizing in patients during remission and reappearing in relapsing/non-responding patients. In a pilot study with 31 patients with MM and transfusion-dependent anaemia, we evaluated the effects of Binocrit (biosimilar epoetin alfa) on transfusions, haemoglobin levels, mental status (mini-mental state evaluation) and the patients’ social-relational functioning and quality of life (QoL). Within a 12-week interval, patients received 40.000 U Binocrit once a week. Binocrit significantly decreased the incidence of transfusion, regardless of the patients’ transfusion history, and significantly increased haemoglobin levels (before-and-after-treatment median haemoglobin values = 8.20 vs. 9.40 g/dl, respectively; Wilcoxon Z test, p < .001). A comparatively greater increment in haemoglobin levels among patients who responded to first vs. additional lines of chemotherapy was also observed. Importantly, we additionally found moderate-to-strong positive associations between increments in haemoglobin levels and corresponding increments both in psychological well-being and QoL (FACT-An scores) and the patients’ cognitive status (mini-mental state evaluation scores). After statistically controlling for possible concurrent benefits of anti-myeloma therapy, increments in haemoglobin levels clearly predicted both increments in socio-relational FACT-An scores (Spearman’s rho = 0.60, p < .001) and in cognitive functioning scores (Spearman’s rho = 0.49, p < .006). Binocrit thus appears as an effective, well-tolerated agent for the management of myeloma anaemia, whose documented benefits include amelioration of anaemia, reduction in transfusion, and improvements in the patients’ social-relational functioning and cognitive well-being.
Multiple myeloma Anaemia Erythroid-stimulating agents (ESAs) Biosimilar epoetin α (Binocrit) Cognitive functioning and psychosocial quality of life (QoL)
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Compliance with ethical standards
The local ethics committee approved the study (N 206 29 June 2013), and all patients gave written informed consent.
Conflict of interest
The authors declare that they have no conflicts of interest.
Winningham ML (2001) Strategies for managing cancer-related fatigue syndrome: a rehabilitation approach. Cancer 92:988–997CrossRefPubMedGoogle Scholar
Cella D, Kallich J, McDermott A, Xu X (2004) The longitudinal relationship of haemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol 15:979–986CrossRefPubMedGoogle Scholar
Cella D (1997) The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 34:13–19PubMedGoogle Scholar
Pantaleo G, Miron AM, Ferguson MA et al (2014) Effects of deterrence on intensity of group identification and efforts to protect group identity. Motiv and Emotion, Special Issue on Effort 38(6):855–865. doi:10.1007/s11031-014-9440-3CrossRefGoogle Scholar
Palazzuoli A, Ruocco G, Pellegrini M et al (2014) The role of erythropoietin stimulating agents in anemic patients with heart failure: solved and unresolved questions. Ther Clin Risk Manag 641. doi:10.2147/TCRM.S61551
Haag-Weber M, Vetter A, Thyroff-Friesinger U, INJ-Study Group (2009) Therapeutic equivalence, long-term efficacy and safety of HX575 in the treatment of anemia in chronic renal failure patients receiving hemodialysis. Clin Nephrol 72:380–390PubMedGoogle Scholar
Castelli R, Deliliers GL, Colombo R et al (2014) Biosimilar epoetin in elderly patients with low-risk myelodysplastic syndromes improves anemia, quality of life, and brain function. Ann Hematol 93:1523–1529. doi:10.1007/s00277-014-2070-8CrossRefPubMedGoogle Scholar
Kerkhofs L, Boschetti G, Lugini A et al (2012) Use of biosimilar epoetin to increase haemoglobin levels in patients with chemotherapy-induced anemia: real-life clinical experience. Future Oncol 8:751–756. doi:10.2217/fon.12.39CrossRefPubMedGoogle Scholar
Rosti G, Petrini M, Bosi A et al. (2016) Managment of anaemia in onco-haematological patients treated with biosimilar epoetin alfa: results of an Italian observational, retrospective study. Therapeutic Advances in Medical Oncology 2016Google Scholar
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
Dammacco F, Castoldi G, Rödjer S (2001) Efficacy of epoetin alfa in the treatment of anaemia of multiple myeloma. Br J Haematol 113:172–179CrossRefPubMedGoogle Scholar
Aapro M, Cornes P, Sun D, Abraham I (2012) Comparative cost efficiency across the European G5 countries of originators and a biosimilar erythropoiesis-stimulating agent to manage chemotherapy-induced anemia in patients with cancer. Ther Adv Med Oncol 4:95–105. doi:10.1177/1758834012444499CrossRefPubMedPubMedCentralGoogle Scholar
Abraham I, Han L, Sun D et al (2014) Cost savings from anemia management with biosimilar epoetin alfa and increased access to targeted antineoplastic treatment: a simulation for the EU G5 countries. Future Oncol 10:1599–1609. doi:10.2217/fon.14.43CrossRefPubMedGoogle Scholar
Caro JJ, Salas M, Ward A, Goss G (2001) Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer 91:2214–2221CrossRefPubMedGoogle Scholar