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Blood, Vol. 92 No. 5 (September 1), 1998:
pp. 1793-1798
Anemia in Children With Cancer Is Associated With Decreased
Erythropoietic Activity and Not With Inadequate Erythropoietin
Production
Francis Corazza,
Yves Beguin,
Pierre Bergmann,
Marie André,
Alina Ferster,
Christine Devalck,
Pierre Fondu,
Marc Buyse, and
Eric Sariban
From the Laboratory of Hematology and of Clinical Chemistry, Brugmann
University Hospital, Brussels; the Department of Hematology, University
of Liège; Hematology-Oncology Unit, Hôpital Universitaire
des Enfants, Brussels; and the International Institute for Drug
Development, Brussels, Belgium.
A defect in erythropoietin (EPO) production has been advocated as
being the main cause of anemia presented at time of diagnosis or during
treatment by adults with solid tumors. On the basis of this defect,
anemic cancer patients, both adults and children, have been treated
with recombinant human EPO (rHuEPO). To further elucidate the
pathophysiology of anemia in children with cancer, we measured serum
soluble transferrin receptor (sTfR), a quantitative marker of
erythropoiesis, and serum EPO at time of diagnosis and during
chemotherapy in children suffering from solid tumor or leukemia. We
determined serum EPO in 111 children (55 leukemia, 56 solid tumors) at
time of diagnosis. In the last 44 patients (23 leukemia and 21 solid
tumors), sTfR levels were also measured. Serum EPO together with sTfR
levels were also determined in 60 children receiving chemotherapy (29 leukemia, 31 solid tumors). These results were compared with those
obtained from appropriate control groups. In all patients, we found a
highly significant correlation between the logarithm of EPO
(log[EPO]) and the hemoglobin (Hb) level. In all subsets of patients,
sTfR levels were inappropriately low for the degree of anemia. Neither
leukemic nor solid tumor groups showed a significant inverse
relationship between log(sTfR) and the Hb level as would be expected in
anemic patients with appropriate marrow response. Thus, in children
with cancer, anemia is associated with a decreased total bone marrow
erythropoietic activity which, in contrast to what has been reported in
anemic cancer adults, is not related to defective EPO production.
© 1998 by The American Society of Hematology.
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