Erythropoietin treatment in chronic phase chronic myeloid leukemia patients treated with frontline imatinib who developed late anemia

Abstract

Background Role of erythropoietin (EPO) in the treatment of late anemia in patients with Chronic Myeloid Leukemia (CML) is still undefined. Methods Fifty CML patients treated at 14 Institutions with frontline imatinib for at least 12 months and in stable complete cytogenetic response who developed a late chronic anemia treated with EPO were retrospectively evaluated. ResultsMedian time from imatinib start to EPO treatment was 42.2 months [interquartile range (IQR) 20.8 -91.9]. Median Hb value at EPO starting time was 9.9 g/dl (IQR 8.9 -10.3): eleven patients (22.0%) were transfusion dependent. Alpha-EPO (40,000 UI weekly) was employed in 37 patients, beta-EPO (30,000 UI weekly) in 9 patients, zeta-EPO (40,000 UI weekly) in 2 patients and darbopoietin (150 mcg/weekly) in the remaining 2 patients. On the whole, 41 patients (82.0%) achieved an erythroid response, defined as a stable (> 3 months) improvement > 1.5 g/dl of Hb level, and 9 patients (18.0%) indeed resulted resistant. Among responding patients, 10 relapsed after a median time from EPO start of 20.7 months . No EPO-related toxicity was observed.Conclusions Results of EPO treatment for late chronic anemia during long-lasting imatinib therapy are encouraging, with a high rate of response.

Small-molecule α-lipoic acid targets ELK1 to balance human neutrophil and erythrocyte differentiation

“…Different cell lineages might be regulated by the same molecules but through different signaling pathways. Anemia is usually observed in myeloid leukemias and during the treatment of myeloid leukemias [ 1 , 7 , 11 , 12 , 14 ]; this observation indicates that genes or pathways exist that regulate both erythropoiesis and myelopoiesis. Identifying the genes or pathways that regulate both erythrocyte and myeloid cell differentiation would help us better understand the relationship between myeloid leukemia and anemia.…”

“…In addition, several case reports show that Fanconi anemia can transform into AML [ 6 – 8 ]. Late anemia [ 9 ], late chronic anemia [ 10 ], and aplastic anemia [ 11 ] can occur in patients with CML treated with imatinib; in such patients erythropoietin treatment may be beneficial [ 12 ]. Impaired erythrocyte differentiation is observed in patients with MDS [ 13 ] and AML [ 14 ].…”