Recombinant human erythropoietin (rhEPO) in the management of anemia and fatigue associated with hematologic malignancies and the myelodysplastic syndromes

Abstract

Anemia is a common complication in patients with chronic lymphocytic leukemia, non- Hodgkin's lymphoma, multiple myeloma, and the myelodysplastic syndromes (MDS). Al though an inappropriately low serum erythro poietin level often correlates with anemia in these malignancies, this is not always the case. Nevertheless, recombinant human erythropoie tin (rhEPO) has been studied in various hemato logic malignancies and in MDS to correct the anemia and avoid the use of red blood cell transfusions. Clinical benefit has been demon strated in most hematologic malignancies or disorders; however, patients with refractory anemia with ringed sideroblasts, a subset of MDS, are resistant to rhEPO therapy. Interest ingly, the combined use of rhEPO and granulo cyte colony-stimulating factor appears to en hance the response in this subset of patients. Most studies did not include extensive phar macoeconomic or quality of life analyses. Thus, it will be important to define more clearly the lowest effective dose and to identify patients with a high probability of response.