Recombinant human erythropoietin (rhEPO) in anemia associated with multiple myeloma and non-Hodgkin’s lymphoma

  • Anders Österborg


Anemia is observed in most patients with multiple myeloma (MM), non-Hodgkin’s lymphoma (NHL) and chronic lymphocytic leukemia (CLL) and may already be manifested at the time of diagnosis. In patients with MM, hemoglobin values <10.0g/dL were found in 49% and severe anemia (hemoglobin <7.5 g/dL) in 19% of the patients already at the time of diagnosis (MRC working party 1980). Patients with NHL have been reported to have an anemia rate of approximately 40% (Coiffier 1999). Anemia usually (but not always, especially in MM) normalizes in patients who achieve complete remission after chemotherapy. However, it persists in patients who are unresponsive to treatment, and recurs in those with relapsing disease. Anemia is a general finding in later phases of the disease, when toxicity of long-term treatment, impairment of renal function, and heavy tumor load contribute to its induction and aggravation.


Multiple Myeloma Chronic Lymphocytic Leukemia Recombinant Human Erythropoietin rhEPO Treatment Cumulative Response Rate 
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  1. Barlogie B, Beck T (1993) Recombinant human erythropoietin and the anemia of multiple myeloma. Stem Cells 11: 88–94PubMedCrossRefGoogle Scholar
  2. Beguin Y, Lampertz S, Bron D, Fillet G (1995) Serum erythropoietin in chronic lymphocyic leukaemia. Br J Haematol 93: 154–156CrossRefGoogle Scholar
  3. Beguin Y, Yerna M, Loo M, Weber M, Fillet G (1992) Erythropoiesis in multiple myeloma: defective red cell production due to inappropriate erythropoietin production. Br J Haematol 82: 648–653PubMedCrossRefGoogle Scholar
  4. Bessho M, Hirashima K, Tsuchiya J (1994) Improvement of anemia in patients with multiple myeloma by recombinant erythropoietin: A multicenter study. Exp Hematol 22: 705 (abstract)Google Scholar
  5. Cazzola M, Mercuriali F, Grugnara C (1997) Use of recombinant human erythropoietin outside the setting of uremia. Blood 89: 4248–4267PubMedGoogle Scholar
  6. Cazzola M, Messinger D, Battistel V, Bron D, Cimino R, Enller-Ziegler L, Essers U, Greil R, Grossi A, Jager G et al (1995) Recombinant human erythropoietin in the anemia associated with multiple myeloma or non-Hodgkin’s lymphoma: Dose finding and identification of predictors of response. Blood 86: 4446–4453PubMedGoogle Scholar
  7. 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 (Suppl 2): 13–19PubMedGoogle Scholar
  8. Coiffier B (1999) Anemia associated with non-platinum chemotherapy (CT) for Hodgkin’s lymphoma (HL) or non-Hodgkin’s lymphoma (NHL). Eur J Cancer 35 (Suppl 4): s331 (abstract)CrossRefGoogle Scholar
  9. Crémieux PY, Barrett B, Anderson K, Slavin MB (2000) Cost of outpatient blood transfusion in cancer patients. J Clin Oncol 18: 2755–2761PubMedGoogle Scholar
  10. Dammacco F, Castoldi G, Rödjer S et al (1997) A placebo-controlled study on the effect of epoetin alpha in patients with multiple myeloma. Blood 90 (Suppl 1): 358aGoogle Scholar
  11. Denton TA, Diamond GA, Matloff JM, Gray GA (1994) Anemia therapy; individual benefit and societal cost. Semin Oncol 21 (2, Suppl 3): 29–35PubMedGoogle Scholar
  12. Denz H, Fuchs D, Huber H, Nachbaur D, Reibnegger G, Thaler J, Werner ER, Wachter H (1990) Correlation between neopterin, interferon-gamma and haemoglobin in patients with haematological disorders. Eur J Haematol 44: 186–189PubMedCrossRefGoogle Scholar
  13. Faquin WC, Schneider TJ, Goldberg MA (1992) Effect of inflammatory cytokines on hypoxia-induced erythropoietin production. Blood 79: 1987–1994PubMedGoogle Scholar
  14. Finch CA, Huebers HA (1982) Perspectives in iron metabolism. N Engl J Med 306: 1520–1528PubMedCrossRefGoogle Scholar
  15. Garton JP, Gerz MA, Witzig TE, Greipp PR, Lust JA, Schroeder G, Kyle RA (1995) Epoetin alfa for the treatment of the anemia of multiple myeloma. A prospective, randomized, placebo-controlled, double-blind trial. Arch Intern Med 155: 2069–2074PubMedCrossRefGoogle Scholar
  16. George CD, Morella PJ (1986) Immunologic effects of blood transfusion upon renal transplantation, tumor operations, and bacterial infections. Am J Surg 152: 329–337PubMedCrossRefGoogle Scholar
  17. Glaspy J (1999) Role of iron in optimizing responses of anemic cancer patients to erythropoietin. Oncology 13: 461–473PubMedGoogle Scholar
  18. Heiss MM, Mempel W, Jauch KW, Delanoff C, Mayer G, Mampel M, Eissner HJ, Schildberg FW (1993) Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery. Lancet 342: 1328–1333PubMedCrossRefGoogle Scholar
  19. Henry D, Glaspy J (1997) Predicting response to epoetin alfa in anemic cancer patients receiving chemorx. Proc Am Soc Clin Oncol 16: 49a (abstract)Google Scholar
  20. Ludwig H, Fritz E, Kotzmann H, Höcker P, Gisslinger H, Barnas U (1990) Erythropoietin treatment of anemia associated with multiple myeloma. N Engl J Med 322: 1693–1699PubMedCrossRefGoogle Scholar
  21. Ludwig H, Leitgeb C, Fritz E, Krainer M, Kuhrer I, Kornek G, Sagaster P, Weissmann A (1993) Erythropoietin treatment of chronic anemia of cancer. Eur J Cancer 29A (Suppl 2): 8–12CrossRefGoogle Scholar
  22. Maxwell MB (1984) When the cancer patient becomes anemic. Cancer Nurs 7: 321–326PubMedCrossRefGoogle Scholar
  23. Means RT, Krantz SB (1991) Inhibition of human erythroid colony-forming units by gamma interferon can be corrected by recombinant human erythropoietin. Blood 78: 2564–2567PubMedGoogle Scholar
  24. Means RT (1995) Pathogenesis of the anemia of chronic disease: a cytokine-mediated anemia. Stem Cells 13: 32–37PubMedCrossRefGoogle Scholar
  25. Medical Research Council’s Working Party on Leukaemia in Adults (1980) Prognostic features in the third MRC myelomatosis trial. Medical Research Council’s Working Party on Leukaemia in Adults. Br J Cancer 42: 831–840CrossRefGoogle Scholar
  26. Mittelman M, Zeidman A, Fradin Z, Magazanik A, Lewinski UH, Cohen A (1997) Recombinant human erythropoietin in the treatment of multiple myelomaassociated anemia. Acta Haematol 98: 204–210PubMedCrossRefGoogle Scholar
  27. Musto P, Falcone A, D’Arena G, Scalzulli PR, Matera R, Minervini MM, Lombardi GF, Modoni S, Longo A, Carotenuto M (1997) Clinical results of recombinant erythropoietin in transfusion-dependent patients with refractory multiple myeloma; role of cytokines and monitoring of erythropoiesis. Eur J Haematol 58: 314–319PubMedCrossRefGoogle Scholar
  28. Musto P (1998) The role of recombinant erythropoietin for the treatment of anemia in multiple myeloma. Leuk Lymphoma 29: 283–291PubMedCrossRefGoogle Scholar
  29. Oster W, Herrman F, Gamm H, Zeile G, Lindemann A, Muller G, Brune T, Kraemer HP, Mertelsmann R (1990) Erythropoietin for the treatment of anemia of malignancy associated with neoplastic bone marrow infiltration. J Clin Oncol 8: 956–962PubMedGoogle Scholar
  30. Pangalis GA, Poziopoulos C, Angelopoulou MK, Siakantaris MP, Panayiotidis P (1995) Effective treatment of disease-related anaemia in B-chronic lymphocytic leukaemia patients with recombinant human erythropoietin. Br J Haematol 89: 627–629PubMedCrossRefGoogle Scholar
  31. Rose E, Rai K, Revicki D, Brown R, Reblando J (1994) Clinical and health status assessments in anemic chronic lymphocytic leukemia (CLL) patients treated with epoetin alfa (EPO). Blood 84 (Suppl 1): 526aGoogle Scholar
  32. Silvestris F, Romito A, Fanelli P, Vacca A, Dammacco F (1995) Long-term therapy with recombinant human erythropoietin (rHu-EPO) in progressing multiple myeloma. Ann Hematol 70: 313–318PubMedCrossRefGoogle Scholar
  33. Singh A, Eckardt KU, Zimmermann A, Gotz KH, Hamann M, Ratcliffe PJ, Kurtz A, Reinhart WH (1993) Increased plasma viscosity as a reason for inappropriate erythropoietin formation. J Clin Invest 91: 251–256PubMedCrossRefGoogle Scholar
  34. Stockman JA III (1996) Anemia of prematurity. Current concepts in the issue of when to transfuse. Pediatr Clin North Am 33: 111–128Google Scholar
  35. Thomas ML (1998) Anemia and quality of life in cancer patients: impact of transfusion and erythropoietin. Medical Oncology 15 (Suppl 3): 13–18Google Scholar
  36. Österborg A, Boogaerts M, Cimino R, Essers U, Holowiecki J, Juliusson G, Jager G, Najman A, Peest D (1996) Recombinant human erythropoietin in transfusion-dependent anemic patients with multiple myeloma and non-Hodgkin’s lymphoma-A randomized multicenter study. Blood 87: 2675–2682PubMedGoogle Scholar
  37. Österborg A (1998) Recombinant human erythropoietin s(rHuEPO) therapy in patients with cancer-related anaemia: What have we learned? Med Oncol 15 (Suppl 1): 47–49Google Scholar
  38. Österborg A, Brandberg Y, Molostova V, Iosova V, Abdulkadyrov K, Hedenus M, Messinger D (2002) Randomized, double-blind, placebo-controlled trial of the effect of epoetin beta on quality of life of patients with hematological malignancies. J Clin Oncol 20: in pressGoogle Scholar

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© Springer-Verlag/Wien 2002

Authors and Affiliations

  1. 1.Department of Oncology (Radiumhemmet)Karolinska HospitalStockholmSweden

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