Erythropoiesis-stimulating agents in elderly patients with anemia: response and cardiovascular outcomes

Gowanlock, Zachary; Sriram, Swetha; Martin, Alison; Xenocostas, Anargyros; Lazo‐Langner, Alejandro

doi:10.1182/bloodadvances.2017007559

Cited by 10 publications

(4 citation statements)

References 36 publications

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“…This “subclinical” inflammatory environment might also affect erythroid differentiation. Indeed, in line with the known age-associated anemia 27,71 our data showed that the entire erythroid lineage is reduced during aging, with a progressive decrease of both immature and committed populations. Since previous studies suggested a reduced sensitivity to erythropoietin (EPO) of aged HSPC 71 further investigations will be required to assess intrinsic vs. extrinsic contribution to this phenomenon.…”

Section: Discussionsupporting

confidence: 85%

Molecular and phenotypic blueprint of the hematopoietic compartment reveals proliferation stress as a driver of age-associated human stem cell dysfunctions

Lettera,

Scala,

Basso-Ricci

et al. 2023

Preprint

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Hematopoietic stem/progenitor cell (HSPC) aging studies have been associated with myeloid skewing, reduced clonal output, and impaired regenerative capacity, but quantitative immunophenotypic and functional analysis across human aging is lacking. Here, we provide a comprehensive phenotypic, transcriptional, and functional dissection of human hematopoiesis across the lifespan. Although primitive HSPC numbers were stable during aging, overall cellularity was reduced, especially for erythroid and lymphoid lineages. Notably, HSPC from aged individuals had superior repopulating frequency than younger counterparts in xenografts; yet aged HSPC displayed epigenetic dysregulation of cell cycle, inflammatory signatures, and a reduced capacity to counteract activation-induced proliferative stress with concomitant accumulation of DNA damage and senescence-like features upon xenotransplantation. This phenotype was recapitulated by enforcing proliferative stress in vivo on cord blood (CB) HSPC. Overall, our work sheds light on dysregulated responses to activation-induced proliferation underlying HSPC aging and establishes CB xenotransplantation-based models as suitable for studying age-associated hematopoietic defects.

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Section: Discussionsupporting

confidence: 85%

Molecular and phenotypic blueprint of the hematopoietic compartment reveals proliferation stress as a driver of age-associated human stem cell dysfunctions

Lettera,

Scala,

Basso-Ricci

et al. 2023

Preprint

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“…57 A retrospective analysis 58 of patients with anemia over aged 60 revealed that those with UAA had inappropriately low EPO levels after adjusting for Hb, eGFR, and comorbidities. Gowanlock et al 59 performed a retrospective analysis of the use of epoetin alfa to treat UAA in 570 patients with anemia over aged 60. They observed a larger increase in Hb in UAA (47%) and CKD (54%) relative to other etiologies (22%) and found that a baseline EPO level < 200 IU/L independently predicted treatment response.…”

Section: Therapies For Uaamentioning

confidence: 99%

Unexplained anemia of aging: Etiology, health consequences, and diagnostic criteria

Guralnik

Ershler

Artz

et al. 2021

J American Geriatrics Society

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Background: Up to 15% of people aged 60 and over are anemic, and the prevalence of anemia increases with age. In older men and women, anemia is associated with increases in the risk of death and all-cause hospitalization, poor functional capacity, quality of life, and depression. Methods and Results:We reviewed the literature describing anemia in aging populations, focusing on the specific diagnostic criteria of anemia and potential causes in older men and women. Even after extensive etiologic workup that involves careful medical history, physical examination, laboratory measurements, and additional studies such as bone marrow biopsy, anemia of aging is unexplained in up to 40% of older patients with anemia. As a result, treatment options remain limited. Conclusions: The prevalence of unexplained anemia of aging (UAA; also called unexplained anemia of the elderly, UAE), its deleterious impacts on health, physical function, and quality of life, and the lack of effective treatment or therapy guidelines represent a compelling unmet clinical need. In this review and consensus document, we discuss the scope of the problem, possible causes of UAA, diagnostic criteria, and potential treatment options. Because even mild anemia is strongly linked to poor clinical outcomes, it should receive clinical attention rather than simply being considered a normal part of aging.

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“…injection of vitamin B12 when needed because of gastrointestinal disease) and s.c. injection of erythropoietin stimulating agents (ESAs) [16,17]. Iron-either oral or parenteral-, comes in different chemical formulations which associate with different efficacy and tolerance [18][19][20]. ESAs also come in different forms, each with benefits and risks [21].…”

mentioning

confidence: 99%

Anemia in the very aged person: how are treatment options discussed and when is red blood cell component transfusion proposed?

Garraud

2022

Transfusion and Apheresis Science

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Erythropoiesis-stimulating agents in elderly patients with anemia: response and cardiovascular outcomes

Abstract: Key Points ESAs can treat anemia of unknown etiology, and responses may be similar to those in CKD. No statistically significant increase in cardiovascular events in those receiving ESAs was detected, but a type II error cannot be excluded.

Cited by 10 publications

References 36 publications

Molecular and phenotypic blueprint of the hematopoietic compartment reveals proliferation stress as a driver of age-associated human stem cell dysfunctions

Molecular and phenotypic blueprint of the hematopoietic compartment reveals proliferation stress as a driver of age-associated human stem cell dysfunctions

Unexplained anemia of aging: Etiology, health consequences, and diagnostic criteria

Anemia in the very aged person: how are treatment options discussed and when is red blood cell component transfusion proposed?

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