Early administration of recombinant erythropoietin improves hemoglobin recovery after reduced intensity conditioned allogeneic stem cell transplantation

Abstract

Summary:The use of recombinant human erythropoietin (rHuEPO) has been controversial after myeloablative allogeneic Stem cell transplantation (allo-SCT). Reduced intensity conditioning regimens (RIC) offer a novel approach that might translate into a different profile of erythropoietic recovery. We treated 20 consecutive patients with rHuEPO early after matched sibling RIC allo-SCT. Conditioning included fludarabine, busulfan and antithymocyte globulin. EPO treatment was analyzed in terms of toxicity, impact on the frequency of Red blood cell transfusions (RBCT) and kinetics of Hemoglobin recovery within the 60 days postallo-SCT. Results were compared with 27 matched patients who did not receive rHuEPO. In the first 2 months after allo-SCT all patients receiving rHuEPO (100%) achieved an Hb level411 g/dl at a median of 30 (15-35) days postallo-SCT, as compared to only 63% of the patients not receiving rHuEPO (P ¼ 0.007) at a median of 35 (20-55) days (P ¼ 0.03). A total of 70% (95% CI, 50-90) of rHuEPO patients maintained an Hb over 11 g/dl in the second month as compared to only 19% (95% CI, 4-34) in the other group (P ¼ 0.0004). For patients receiving RBCT, the use of rHuEPO was associated with a trend towards reduced RBCT requirements. This pilot study suggests a potential benefit of early administration of rHuEPO after RIC allo-SCT on early erythropoietic recovery. Bone Marrow Transplantation (2005) 36, 901-906.

Recombinant human erythropoietin therapy after allogeneic hematopoietic cell transplantation with a nonmyeloablative conditioning regimen: Low donor chimerism predicts for poor response

“…Comparison with our trial is difficult because they did not report on more standard response criteria (proportion of patients achieving Hb response or Hb correction), used a more intensive conditioning regimen, and provided systematic oral iron supplementation compared to more targeted intravenous iron supplementation in our trial. For patients receiving RBC transfusions, their use of rHuEPO was associated with a trend towards reduced requirements [37]. The same authors also previously showed that RBC transfusion needs after NMSCT correlated inversely with pretransplant Hb levels [36].…”

“…All these findings indicate that, after NMSCT, the pathophysiology of endogenous EPO production does not account for response to rHuEPO therapy. There is only a single other study investigating the impact of rHuEPO therapy starting on day 1 after NMSCT in 20 patients [37]. All of them, vs only 63% of controls, achieved an Hb level greater than 11 g/dL after a median of 30 days and 70% of them, vs only 19% of controls, maintained it in the second month.…”

“…However, although both red blood cell (RBC) and platelet transfusion requirements are reduced in NMHCT compared to conventional PBSCT [12,[34][35][36], many NMHCT recipients experience prolonged anemia and many of them still require RBC transfusions [12,34,36]. A pilot study has shown that early rHuEPO therapy could be effective in this setting [37].…”

Granulocyte and erythropoietic stimulating proteins after high-dose chemotherapy for myeloma

“…Other investigators have also reported benefit for treatment with rHuEpo after allogeneic transplant. 78,79 Exploiting the same argument as in the autologous setting, Baron et al 80 showed that treatment with rHuEpo starting at day þ 30 or beyond, in patients transplanted with allogeneic peripheral blood stem cells, resulted in transfusion independence within 2 weeks in 12/13 patients versus 50% of patients in an historical control group. The mean Hb concentrations were significantly higher in the treatment compared to the control groups from day þ 60 post-transplant.…”

Transfusions after nonmyeloablative or reduced-intensity conditioning regimens

“…17 Two recent studies have investigated the use of Epo after nonmyeloablative conditioning or RIC. 35,36 Ivanov et al 35 gave Epo (either 30 000 IU epoetin-beta or 150 mg darbepoetinealpha per week, started on day 1) to 20 consecutive patients following RIC allogeneic HCT (Epo group). Conditioning combined fludarabine, busulfan and ATG.…”