Hemoglobin Fluctuations and Correlation with Quality of Life and Fatigue

  • G. Caocci
  • R. Baccoli
  • G. La Nasa
Reference work entry


A reduction of  Hemoglobin (Hb) levels is common in patients with hematologic malignancies such as  Multiple Myeloma (MM) and  Myelodysplastic syndromes (MDS) and is a frequent complication of myelosuppressive chemotherapy.  Anemia is often associated with a severe impact on physical well-being, quality of life (QOL) and fatigue. Treatment of anemia requires red blood cell (RBC) transfusions, but in a high proportion of patients it is possible to achieve sustained levels of Hb with  recombinant human erythropoietin (rHuEPO and Darbepoetin alfa). Although Hb levels are routinely used to assess the severity of anemia, this numeric gradient does not clearly correlate with the clinical symptoms of anemia, which may be different among patients with the same Hb levels. Hematologic patients under poly-transfusion or treated with erythropoietin-stimulating agents may experience recurrent Hb fluctuations. Repeated RBC transfusions are associated with highly variable and unstable Hb concentrations and the fluctuating Hb may negatively influence homeostasis. Dynamic Hb fluctuations may increase fatigue and ulteriorly aggravate QOL due to recurrent “down-up-down” Hb excursions. These considerations prompted a group of researchers to create a mathematical model capable of transforming measurements of Hb fluctuations into a numerical parameter (  Variaglobin Index) and to correlate this parameter with quality of life and fatigue. Among transfusion-dependent MDS patients and transfusion-free MDS and MM patients (MDS patients treated with rHuEPO and MM patients treated with derbepoietin alfa), a lower amplitude of the Variaglobin Index was found to be significantly correlated with a better quality of life and less fatigue. No significant differences were observed for the amplitude of Hb fluctuations when comparing patients treated with Darbepoetin alfa or rHuEPO.

This innovative mathematical model makes it easy to monitor anemia in oncohematologic patients and to adjust therapy accordingly.


Multiple Myeloma Darbepoetin Alfa Recombinant Human Erythropoietin International Prognostic Scoring System Hematologic Patient 

List of Abbreviations:


European Organization for Research and Treatment Of Cancer






 International Prognostic Scoring System


myelodysplastic syndromes


multiple myeloma


quality of life questionnaire with 30 items


quality of life


red blood cell


recombinant human erythropoietin


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© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • G. Caocci
  • R. Baccoli
  • G. La Nasa

There are no affiliations available

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