Erythropoietin treatment of anemia associated with multiple myeloma

Article Abstract:

Multiple myeloma is a blood disease characterized by tumors, usually in bone, which secrete immunoglobulin, a protein. In addition, patients with multiple myeloma often suffer from anemia (a deficiency of red blood cells or hemoglobin, the molecule that carries oxygen in the blood). Anemia reduces the quality of life for these patients, since it is associated with fatigue and depression, as well as cardiac and respiratory problems. It is possible that administration of erythropoietin, a substance that induces red blood cell formation, would help such patients. This hypothesis was tested in 13 patients with advanced multiple myeloma and severe anemia. They received recombinant (manufactured) erythropoietin three times per week for six months. Blood samples were obtained at regular intervals and analyzed for erythropoietin levels, hemoglobin, and other factors. In addition, the levels of serum M component, a marker for multiple myeloma, were determined. Bone marrow samples were evaluated for their iron content and marrow cells were cultured to evaluate the extent of erythropoiesis (formation of new red blood cells, or erythrocytes). The results showed that 11 patients responded to erythropoietin therapy by demonstrating an increase of at least 1.2 millimoles (2 grams per deciliter) per liter in hemoglobin concentration. Reticulocyte (young erythrocytes) levels also rose during treatment. The levels of serum M component did not change. Factors associated with iron and iron storage reflected the effects of treatment. The marrow cells grown in tissue culture revealed an increase in the number of cells associated with erythrocyte proliferation. In addition, the patients' clinical symptoms improved considerably after erythropoietin therapy. It appears that this approach can lead to substantial improvement in anemia among multiple myeloma patients, and can eliminate the need for blood transfusions. Whether erythropoietin therapy would be effective against other types of cancer affecting blood cells remains to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Multiple myeloma

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Erythropoietin

Article Abstract:

Areview is presented of the therapeutic uses of recombinant (gene recombination) erythropoietin (epoetin), the hormone that directs the manufacture of new red blood cells (erythrocytes) by the bone marrow. Erythropoietin is produced by cells in the kidney in response to changing blood levels of oxygen; the hormone travels through the circulation to the bone marrow, where it triggers the maturation of cells destined to become erythrocytes (progenitor cells). Under normal conditions, the system allows the production of enough erythrocytes to replace aged cells and to keep the levels of oxygen (carried in the erythrocytes) constant. The development of epoetin in 1985 as a product of molecular biology has allowed treatment of diseases associated with anemia (insufficient red blood cells or reduced ability of the cells that are present to carry oxygen). These include kidney failure (when the mechanism that senses low blood levels of oxygen and directs synthesis of erythropoietin does not function properly) and prematurity (premature infants do not appear to make enough erythropoietin), for which the use of erythropoietin is still under investigation. Blood donors with rare blood types can donate more blood if given erythropoietin, as can those who donate blood for their own subsequent use in surgery. The advisability of erythropoietin use by athletes to increase their red cell mass is under debate. People who are anemic may vary considerably in their blood levels of erythropoietin; this variability may affect their ability to respond to the drug. A discussion is presented of treatment of anemic patients with erythropoietin levels above or below 500 units per liter. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Resistance to erythropoietin

Article Abstract:

The emerging resistance to recombinant erythropoietin requires new approaches to the treatment of anemia. Therapy with commercially available erythropoietin, a synthetic hormone that stimulates red blood cell production, benefits a large group of patients with anemias of kidney failure, chronic diseases, and cancer. According to two 1996 studies, cases of resistance to erythropoietin have developed, indicating impaired immune levels responsive to erythropoietin, an expensive therapy. Since only 60% of anemic cancer patients benefit from erythropoietin therapy, treatment effectiveness needs to be established early. Attention to patient selection, cost-benefit analysis, and therapeutic alternatives are important issues. Improving the erythropoietin molecule and administration via gene therapy may be future solutions provided the costs are kept low.

Editorial, Prevention, Drug resistance, Erythropoietin, Recombinant, Recombinant erythropoietin

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