Erythropoietin Treatment in Allogeneic Bone Marrow Transplantation: A Prospective and Randomized Trial

Jl, Steegmann; Lopez, J.; Berberana, M.; Otero, M. J.; Lamana, María L.; Cámara, Rafael de la; Gonzalez, R. Reina; Diaz, A.; Barbera, G; Fernández-Rañada, JM

doi:10.1007/978-3-642-48715-6_79

Cited by 14 publications

(24 citation statements)

References 6 publications

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“…It has no significant impact on quality of life (QOL) and is not cost effective. [6][7][8][9] Recent EORTC guidelines for the use of erythropoietic proteins in anemic patients with cancer state that for patients undergoing allo-SCT, the clinical impact of erythropoietins is limited and they can only be recommended on an individual basis. 10 Recently, better understanding of the mechanisms of allogeneic antitumoral control challenged the need for myeloablation during allo-SCT conditioning.…”

Section: Discussionmentioning

confidence: 99%

“…Although low levels of serum erythropoietin were documented after standard myeloablative allo-SCT, the use of rHuEPO did not translate into a substantial improvement in erythropoietic recovery or major reduction of RBCT requirements. 6,23,24 Profound myeloablation resulting from standard conditioning is likely to induce elimination of progenitor cells targeted by EPO. This might explain, at least in part, these poor results.…”

Section: Discussionmentioning

confidence: 99%

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Early administration of recombinant erythropoietin improves hemoglobin recovery after reduced intensity conditioned allogeneic stem cell transplantation

Ivanov

Faucher

Mohty

et al. 2005

Bone Marrow Transplant

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Summary:The use of recombinant human erythropoietin (rHuEPO) has been controversial after myeloablative allogeneic Stem cell transplantation (allo-SCT). Reduced intensity conditioning regimens (RIC) offer a novel approach that might translate into a different profile of erythropoietic recovery. We treated 20 consecutive patients with rHuEPO early after matched sibling RIC allo-SCT. Conditioning included fludarabine, busulfan and antithymocyte globulin. EPO treatment was analyzed in terms of toxicity, impact on the frequency of Red blood cell transfusions (RBCT) and kinetics of Hemoglobin recovery within the 60 days postallo-SCT. Results were compared with 27 matched patients who did not receive rHuEPO. In the first 2 months after allo-SCT all patients receiving rHuEPO (100%) achieved an Hb level411 g/dl at a median of 30 (15-35) days postallo-SCT, as compared to only 63% of the patients not receiving rHuEPO (P ¼ 0.007) at a median of 35 (20-55) days (P ¼ 0.03). A total of 70% (95% CI, 50-90) of rHuEPO patients maintained an Hb over 11 g/dl in the second month as compared to only 19% (95% CI, 4-34) in the other group (P ¼ 0.0004). For patients receiving RBCT, the use of rHuEPO was associated with a trend towards reduced RBCT requirements. This pilot study suggests a potential benefit of early administration of rHuEPO after RIC allo-SCT on early erythropoietic recovery. Bone Marrow Transplantation (2005) 36, 901-906.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early administration of recombinant erythropoietin improves hemoglobin recovery after reduced intensity conditioned allogeneic stem cell transplantation

Ivanov

Faucher

Mohty

et al. 2005

Bone Marrow Transplant

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“…transplantation the benefit of rHuEPO therapy was minimal when it was given early posttransplant [21][22][23][24][25][26][27][28][29][30][31][32] but could be optimized when started after day 30 [32], we first administered rHuEPO starting on day 30 after the transplant. However, as the degree of myelosuppression after NMSCT was mild [13], we also started rHuEPO therapy on the day of transplantation in another group of patients, achieving complete Hb correction at similar speed and frequency.…”

Section: Weeks After Nmsctmentioning

confidence: 99%

“…Numerous trials have shown that there is a major need for efficient erythropoiesis enhancement to alleviate chronic anemia and reduce the high transfusion requirements after HCT. However, recombinant human erythropoietin (rHuEPO) therapy offers minimal (in case of allogeneic HCT) or no (in case of autologous HCT) benefit when rHuEPO is started immediately after the transplant [21][22][23][24][25][26][27][28][29][30][31][32]. On the other hand, we have shown that rHuEPO was remarkably efficient when started around day 30 after transplantation with a myeloablative conditioning regimen, i.e., when endogenous EPO production becomes impaired, and this was true for both allogeneic [32] and autologous [20] HCT.…”

mentioning

confidence: 99%

Recombinant human erythropoietin therapy after allogeneic hematopoietic cell transplantation with a nonmyeloablative conditioning regimen: Low donor chimerism predicts for poor response

Vanstraelen¹,

Baron²,

Willems

et al. 2006

Experimental Hematology

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“…In contrast, clinical trials of rhEpo therapy after allogeneic bone marrow transplantation (BMT) resulted in accelerated erythroid engraftment and some reduction in transfusion requirements [17,18,[23][24][25][26][27][28][29][30]. However, in all of these studies, the rhEpo dose used was very high (greater than 1000 U/kg/ week) and thus the cost was prohibitive.…”

mentioning

confidence: 99%

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

Baron

Sautois

Baudoux

et al. 2002

Experimental Hematology

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Objective. Allogeneic hematopoietic stem cell transplantation (HSCT) is associated with prolonged anemia caused by defective erythropoietin (Epo) production. We enrolled 34 recipients of an allogeneic HSCT in three consecutive trials to determine the optimal utilization of recombinant human erythropoietin (rhEpo) therapy in this setting. Materials and Methods. In the first trial (n ϭ 7), rhEpo 1400 U/kg/week was given from day 1 until a hemoglobin (Hb) level of 10 g/dL was achieved, for a maximum of 60 days. In the second trial, rhEpo 500 U/kg/week was given to achieve Hb levels of 13 to 14 g/dL in 13 anemic patients with fatigue 56 to 1440 days after transplant. In the third trial, rhEpo was scheduled to start on day 35 in 14 patients at a dose of 500 U/kg/week with the aim of achieving Hb levels of 13 to 14 g/dL. Results. In trial 1, erythroid recovery to 1% reticulocytes and red blood cell transfusion independence were faster, but the number of transfusions was not reduced compared to 10 controls. Responses were brisk in trial 2, with transfusion independence achieved after a median of 1 week in 12 of 13 patients, and 2-g Hb increments or Hb values of 11, 12, and 13 g/dL after 6, 7, 10, and 10 weeks, respectively. Transfusions were significantly reduced in the first month of rhEpo therapy. In trial 3, transfusion independence was obtained after a median of 1 week in 13 of 14 patients, and 2-g Hb increments or Hb values of 11, 12, and 13 g/dL after 3, 4, 6, and 8 weeks, respectively. Transfusions rates were considerably reduced compared to the previous month in the same patients or compared to controls undergoing peripheral blood or marrow transplant without rhEpo. Conclusions. Anemia after allogeneic HSCT is exquisitely sensitive to rhEpo. The benefit is minimal when it is given early post-transplant, as used in all trials to date. However, the rate of major response is greater than 90% when rhEpo is started after day 35. These data provide the basis on which to conduct a prospective, randomized, placebo-controlled trial of rhEpo therapy after allogeneic HSCT.

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Erythropoietin Treatment in Allogeneic Bone Marrow Transplantation: A Prospective and Randomized Trial

Cited by 14 publications

References 6 publications

Early administration of recombinant erythropoietin improves hemoglobin recovery after reduced intensity conditioned allogeneic stem cell transplantation

Early administration of recombinant erythropoietin improves hemoglobin recovery after reduced intensity conditioned allogeneic stem cell transplantation

Recombinant human erythropoietin therapy after allogeneic hematopoietic cell transplantation with a nonmyeloablative conditioning regimen: Low donor chimerism predicts for poor response

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

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