Distribution of serum erythropoietin levels in Japanese patients with myelodysplastic syndromes

Abstract

Erythropoiesis-stimulating agents (ESAs) are used to ameliorate anemia in lower-risk myelodysplastic syndromes (MDS). Serum erythropoietin (EPO) level <500 IU/L is widely accepted as a major predictive factor for response to ESAs. However, few data about EPO levels in the Japanese population are available. We therefore evaluated distribution of serum EPO levels in Japanese patients with MDS. Forty-three cases were analyzed; 30 were classified as lower-risk MDS (low or intermediate-1 by the international prognostic scoring system). Twenty-two cases were transfusion dependent. The overall median hemoglobin level was 7.7 g/dL. The median value of serum EPO was 254 IU/L (range: 16.4-23,000). Serum EPO levels had a strong inverse correlation with hemoglobin levels, and a significantly larger proportion of patients showed high EPO levels (>500 IU/L) in the transfusion-dependent group. In the higher-risk group, no significant correlation between EPO and hemoglobin was observed. Regression analyses showed that serum EPO of 500 IU/L corresponds to 8.29 g/dL of hemoglobin in lower-risk MDS. The results indicate that patients with hemoglobin levels of 8.0 g/dL or more, who are still transfusion independent, may be good candidates for ESA treatment.

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

“…Similar results were also obtained in studies abroad, although the EPO levels increased up to~100 mIU/mL in some patients with stage 3 CKD [5,6]. In contrast, EPO levels were >50 mIU/mL in most patients with hematological diseases [3,4].…”

“…In these reports, most patients with hematopoietic disorders such as aplastic anemia and myelodysplastic syndromes (MDS) with Hb levels of <10 g/dL showed serum EPO levels of >50 mIU/ mL [by radioimmunoassay or the chemiluminescent enzyme immunoassay (CLEIA)] [3,4], whereas most CKD patients showed serum EPO levels of <50 mIU/mL [by enzyme-linked immunosorbent assay (ELISA) or the CLEIA method] [5,6] (different measurement methods may affect the measured value of EPO, but such an effect has not been examined). Moreover, it has been reported that the increase in EPO level in response to the decrease in Hb level is suppressed at more advanced stages of CKD [6].…”

The prognostic value of serum erythropoietin in patients with lower-risk myelodysplastic syndromes: a review of the literature and expert opinion

“…Conversely, elevating sEPO levels with ESAs is more likely to be beneficial among patients with lower levels. Some studies have shown that sEPO levels have a strong inverse correlation with hemoglobin levels in lower-risk MDS patients [35,75], suggesting that patients with worse anemia (i.e., lower hemoglobin) may have higher levels of sEPO. Patients who are resistant to ESAs have higher sEPO and lower hemoglobin levels than those who respond (Tables 1 and 2), so these factors may be indicative of reduced bone marrow responsiveness.…”

Erythropoietin inhibits osteoblast function in myelodysplastic syndromes via the canonical Wnt pathway

“… 27 However, the erythroid response is observed in a relatively low number of patients and often not sustained, 28 which is in part due to endogenously elevated erythropoietin levels because of ineffective erythropoiesis in many patients. 29 We speculated that a sustained endogenous elevation of erythropoietin levels or iatrogenic erythropoietin therapy in MDS patients might contribute to the dysregulation of the osteo-hematopoietic niche, at least partly due to its effects on MSC and osteoblasts.…”