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Serum erythropoietin levels in patients receiving intensive chemotherapy
and radiotherapy
L Schapira, JH Antin, BJ Ransil, KH Antman, JP Eder, CJ McGarigle and MA Goldberg
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
To investigate the potential role of recombinant human erythropoietin
(rhEpo) in patients receiving intensive cytotoxic therapy, we measured the
endogenous levels of Epo in 31 patients undergoing bone marrow
transplantation (BMT). Seventeen patients underwent allogeneic BMT and 14
underwent autologous BMT. On average, 10 +/- 4 units of red blood cells
(RBCs) were transfused per patient. The mean RBC transfusion requirement of
the autologous BMT patients was significantly greater than that of the
allogeneic recipients (12 +/- 3 v 8 +/- 4, P less than .01), although both
groups were maintained at comparable hematocrits. Epo levels were measured
by radioimmunoassay (RIA). For each patient, baseline serum Epo levels were
determined at time of admission to the hospital. Subsequent samples were
collected within 24 hours of completing chemotherapy and/or radiotherapy,
and on days 7, 14, and 28, after BMT. Hematocrits (Hcts) were measured
daily. All patients had an initial serum creatinine less than or equal to
1.5 mg/dL. Despite considerable differences in absolute Epo levels among
individuals, a characteristic pattern was observed. Following admission to
the hospital and initiation of cytotoxic therapy, the average Hct decreased
and the average Epo level initially increased. The mean serum Epo levels
peaked on day 7 post-BMT (284 +/- 190 mU/mL) and fell steadily thereafter.
While the average Hcts on day 7 and on day 28 post-BMT were not
significantly different (28 +/- 4.6% v 29 +/- 3.3%, respectively), the
average serum Epo levels decreased fourfold (P less than .01) during this
same period. Moreover, day 28 post-BMT mean Epo levels were inappropriately
low (P less than .05) when compared with a reference population with bone
marrow failure and normal controls who had not received cytotoxic therapy.
We conclude that the endogenous Epo response appears to be blunted during
the 3 to 4 weeks immediately post- BMT. Therefore, clinical trials
assessing the efficacy of the administration of rhEpo in the treatment of
anemias associated with cytotoxic therapy are warranted.
Volume 76,
Issue 11,
pp. 2354-2359,
12/01/1990
Copyright © 1990 by The American Society of Hematology
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