Inappropriate Increase in Plasma Erythropoietin Levels Following PEB Chemotherapy

Abstract

Background: In order to obtain more information on the influence of chemotherapy on erythropoietin (EPO) regulation, the change of serum levels in correlation with the respective hemoglobin value was studied. Material and Methods: Six male patients (age 22-45 years) with testicular cancer were followed over a total of 21 cycles of chemotherapy according to the PEB regimen (Cisplatin 100 mg/m2, Etoposide 500 mg/m2, Bleomycin 60 mg/m2, total intravenous dose administered over 8 days, every 4 weeks). The EPO concentration was measured by radioimmunoassay. Sera from patients with acute blood loss or from healthy individuals served as controls. No impairment of renal or hepatic function was observed during or after PEB chemotherapy. Results: Prior to chemotherapy, EPO levels proved to be adequate when compared with the controls, ranging between 35 and 65 U/l at hemoglobin (Hb) levels above 12 g/dl. In the majority of cases chemotherapy was followed by merely mild anemia (Hb > 10 g/dl). Nevertheless, a 3.4-fold increase in EPO levels was observed during chemotherapy (35-354 U/l EPO, median 150 U/l). EPO levels were highest 6-8 days after the beginning of intravenous chemotherapy and then steadily declined, in most cases to even normal values prior to the next chemotherapy cycle. The elevation of EPO was significantly higher than that found in controls with a similar reduction of Hb levels due to acute blood loss. Conclusion: Chemotherapeutic agents or their combination are able to induce elevated EPO levels due to mechanisms unrelated to the anemia induced.