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Recombinant human erythropoietin in transfusion-dependent anemic patients
with multiple myeloma and non-Hodgkin's lymphoma--a randomized multicenter
study. The European Study Group of Erythropoietin (Epoetin Beta) Treatment
in Multiple Myeloma and Non-Hodgkin's Lymphoma
A Osterborg, MA Boogaerts, R Cimino, U Essers, J Holowiecki, G Juliusson, G Jager, A Najman and D Peest
Department of Oncology (Radiumhemmet), Karolinska Hospital, Stockholm,
Sweden.
One hundred twenty-one anemic, transfusion-dependent patients with multiple
myeloma (MM) or low-grade non-Hodgkin's lymphoma (NHL) were randomly
allocated to receive (a) recombinant human erythropoietin (rhEPO) 10,000
U/d subcutaneously 7 days a week (fixed dose group) (n = 38), or (b) rhEPO
2,000 U/d subcutaneously for 8 weeks followed by step- wise escalation of
the rhEPO dose (titration group) (n = 44), or (c) no rhEPO therapy (control
group) (n = 39). The total treatment period was 24 weeks. There were no
differences between the three groups with regard to baseline clinical,
demographic, or health status measures. The cumulative response frequency,
defined as elimination of the transfusion need in combination with an
increase in the hemoglobin concentration by >20 g/L, was 60% in both
rhEPO treatment groups and 24% in the control group (P = .01 and .02,
respectively, log rank test). For patients in the titration group the
response rate on the first dose level (2,000 U/d) was only 14%. Cox's
univariate regression analysis revealed that an inadequately low endogenous
erythropoietin concentration in relation to the degree of anemia and a
baseline platelet concentration > or = 100 x 10(9)/L were significant
predictors for response to rhEPO therapy (P < .01). Multivariate
regression analysis showed that relative erythropoietin concentration was
the most important factor and the platelet count had no additional
influence on response. Treatment with rhEPO was well tolerated. We conclude
that treatment with rhEPO may be indicated in anemic MM and NHL patients
with a relative erythropoietin deficiency. An initial dose of 5,000 U/d
subcutaneously may be recommended.
Volume 87,
Issue 7,
pp. 2675-2682,
04/01/1996
Copyright © 1996 by The American Society of Hematology
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