A randomized study of erythropoietin and granulocyte colony-stimulating
factor (G-CSF) versus placebo and G-CSF for patients with Hodgkin's and
non-Hodgkin's lymphoma undergoing autologous bone marrow transplantation
NJ Chao, JR Schriber, GD Long, RS Negrin, M Catolico, BW Brown, LL Miller and KG Blume
Bone Marrow Transplantation Program, Stanford University, CA.
Anemia is a universal finding in patients undergoing autologous bone marrow
transplantation (BMT). Effective therapies to increase the number of
autologous red blood cells could result in a lower morbidity and mortality
associated with red blood cell transfusions. We examined whether the
addition of erythropoietin (Epo) to intensive therapy supported by
progenitor cell transplantation and granulocyte colony- stimulating factor
(G-CSF) would result in a lower requirement for red blood cell
transfusions. Thirty-five patients with lymphoma were randomized to receive
Epo versus placebo. Epo (600 U/kg three times per week) or placebo was
begun 3 weeks before administration of high-dose therapy. Epo was held
during the week of the preparatory regimen, and restarted on the day after
BMT. All patients also received G-CSF following BMT. No significant
differences were noted between the two groups in terms of patient
characteristics at pretreatment or post-BMT evaluation. There were no
differences in the total number of red blood cell units transfused (median
Epo: 8 v placebo: 6, P = .22) nor the number of platelet transfusions given
(median Epo: 12 v placebo 5, P = .14). Engraftment of granulocytes
(absolute neutrophil count > or = 500/microL) occurred in a median of 12
days (range, 9 to 33) for the patients receiving Epo and G-CSF, compared
with a median of 10 days (range, 8 to 22) for those receiving placebo and
G-CSF (P = .70). Likewise, there were no differences in the time to
platelet count > or = 20,000/microL without further transfusions with a
median of 22 days (range, 15 to 150+) for those receiving Epo and G-CSF
compared with a median of 20 days (range, 11 to 54) for those patients
receiving placebo and G-CSF (P = .28). The combination of G-CSF and Epo as
administered in this study appears to be safe but does not result in an
improvement in the total number of red blood cell transfusions or total
number of single donor platelet units transfused.
Volume 83,
Issue 10,
pp. 2823-2828,
05/15/1994
Copyright © 1994 by The American Society of Hematology
