Serum erythropoietin changes in autologous and allogeneic bone marrow transplant patients

Abstract

Sequential changes in serum erythropoietin (sEPO) levels were measured by radioimmunoassay in six patients receiving autologous rescue (AR) and 11 patients receiving an allogeneic bone marrow transplant (BMT) for malignant disease. Longitudinal studies showed an inverse relationship between sEPO and haemoglobin levels in the autologous rescue and allogeneic transplant patients throughout the 130 d post-transplant study period. Early post-conditioning EPO responses were normal for the haemoglobin level in both groups, but after day 14 post-transplant, erythropoietin production in response to anaemia became impaired in one autologous rescue patient and eight of the 11 allogeneic transplant patients. There was no clear association between late impairment of sEPO production and conditioning therapy, infection, graft-versus-host disease, immunosuppressive therapy or serum creatinine. Blood transfusion requirements were similar for both groups in the first month after transplantation, but from days 31 to 90 post-transplant, BMT patients required an average of 5.5 units per patient compared with 1 unit per patient for the autologous group. Marrow transplant procedures do not affect early EPO responses but may diminish late responses. The potential value of exogenous rHuEPO in hastening engraftment and decreasing transfusion requirements, particularly for those patients who appear to have impaired EPO responses, remains to be shown by clinical trials.

Kinetics of hemopoietic recovery after peripheral blood stem cell transplantation: Impact of stem cell purification and G‐CSF

“…These data are in contrast with those reported after ABMT [24,25]. It is commonly accepted that sEPO levels are appropriately related to anemia during ABMT but impaired during allogeneic BMT [25,26]. The only correlation we found was between sEPO levels and reticulocytes count when uPBSC were re-infused.…”

Optimization of recombinant human erythropoietin therapy after allogeneic hematopoietic stem cell transplantation

“…With marrow recovery, Epo levels progressively return to an appropriate range, and the duration of this correction phase inversely correlates with the speed of engraftment [11]. Thereafter, endogenous Epo remains appropriate for the degree of anemia in autologous transplants [6,7,[10][11][12][13][14][15] but rapidly becomes inadequately low in allogeneic transplants [7][8][9][13][14][15]. This defect in Epo production is attributed to the use of cyclosporin A [33,34], which inhibits Epo secretion [35], but acute GVHD [8,[13][14][15] or cytomegalovirus infection [13,15] also contribute.…”

“…Thereafter, endogenous Epo remains appropriate for the degree of anemia in autologous transplants [6,7,[10][11][12][13][14][15] but rapidly becomes inadequately low in allogeneic transplants [7][8][9][13][14][15]. This defect in Epo production is attributed to the use of cyclosporin A [33,34], which inhibits Epo secretion [35], but acute GVHD [8,[13][14][15] or cytomegalovirus infection [13,15] also contribute. Therefore, the development of erythropoiesis after autologous transplantation is limited by the availability of Epo receptor-bearing erythroid precursors rather than the supply of Epo, whereas after allogeneic HSCT erythropoietic recovery is impaired because Epo levels remain inadequate for prolonged periods of time [14].…”

“…Median time to 1% reticulocytes was 12 days (range [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] in the study group vs 27 days (range 13-72) in the control group ( p ϭ 0.0177). Neutrophil and platelet engraftments were not different.…”

Erythropoiesis after nonmyeloablative stem-cell transplantation is not impaired by inadequate erythropoietin production as observed after conventional allogeneic transplantation

“…However, after allogeneic SCT, the Epo response to anemia then generally becomes impaired, resulting in inappropriately low Epo levels for the degree of anemia and prolonged anemia (21,24). This is specific for allogeneic transplants because serum Epo levels remain adequate throughout the posttransplant course in recipients of an autologous marrow or PBSC transplant (19,20,22,23,(25)(26)(27)(28). This defect in Epo production has been attributed to the use of cyclosporine (29), which does not affect the expression of the Epo gene but causes an inhibition of Epo secretion (30).…”