Recombinant Human Erythropoietin Treatment for Chemotherapy-related Anemia in Children

Abstract

ABSTRACT. Objective. The efficacy and safety of recombinant human erythropoietin (rHuEPO) treatment in chemotherapy-induced anemia in children were investigated. rHuEPO is used to treat chemotherapy-induced anemia. Several studies recommend 150 to 300 IU/kg rHuEPO for 2 to 8 months. There are only a few controlled trials in children and no precise data about the optimal dose and duration of rHuEPO treatment is available.Patients and Methods. Thirty-four patients receiving chemotherapy for treatment of their solid tumors between October 1996 and June 1997 were included in this study. Patients were randomly selected for each group. The male/female ratio was 20/14, and the median age was 5 years (range, 1-16 years). They had normal hemoglobin levels at the time of diagnosis. When hemoglobin levels decreased to levels lower than 10 g/dL, rHuEPO (150 IU/kg/d, 3 times a week, subcutaneously) was given to 17 patients for 2 months. Their renal, liver, and pulmonary functions were normal. None of the patients had hematologic disease. We did not use any other drugs such as iron or granulocyte colony-stimulating factor. There were 17 patients in the control group. Fifteen patients got chemotherapy regimens including cisplatin (CDDP), but 19 were treated with regimens without CDDP. At the end of rHuEPO treatment, all patients were examined in terms of transfusion requirements and rate of change in hemoglobin levels.Results. One patient in the study group needed a blood transfusion, whereas 8 patients needed a transfusion in the control group. Patients in the study group had less transfusion requirements compared with the control group. The mean hemoglobin levels before and after the study were 8.48 ؎ 0.98 g/dL and 8.41 ؎ 1.65 g/dL in the control group and 8.50 ؎ 0.85 g/dL and 10.21 ؎ 2.14 g/dL in the rHuEPO group, respectively. Optimal hemoglobin increments began in 4 weeks and continued during treatment. CDDP-receiving and CDDP-nonreceiving groups did not have any difference in pretreatment serum erythropoietin levels. rHuEPO treatment was more effective in patients treated with non-CDDP regimens. Mean hemoglobin level increased from 8.68 ؎ 0.73 g/dL to 10.26 ؎ 1.84 g/dL in 9 patients treated with non-CDDP chemotherapy regimens in the erythropoietin group, although it increased from 8.28 ؎ 0.97 g/dL to 10.15 ؎ 2.5 g/dL in 8 patients treated with CDDP-containing regimens in the erythropoietin group. rHuEPO caused high blood pressure in only 1 patient that resolved spontaneously after cessation of erythropoietin treatment for a week.Conclusion. rHuEPO treatment (150 IU/kg/d 3 times a week) is effective and safe in children with chemotherapy-induced anemia. It decreases blood transfusion requirements in solid tumor patients. Our results show that the response to rHuEPO in CDDP-induced anemia is less than the response in non-CDDP receiving patients. Higher doses may be necessary in patients using CDDP. Pediatrics 1999;103(2). URL: http://www.pediatrics.org/ cgi/content/full/103/2/e16; erythropoietin, solid tumors, chemotherapy...

A SINGLE INSTITUTIONAL EXPERIENCE: Is Epoetin Alpha Effective in Anemic Children with Cancer?

“…Therefore, use of erythropoeitin appears to be an option for treatment of anemia in children who undergo concomitant chemotherapy [14]. There are only a few studies that have investigated the role of epoetinalpha in children with cancer, however, no precise data about optimal dose and duration of erythropoietin are available in the current literature [8][9][10][11][12][13]. In a phase I-II study done by Beck and Beck [10], short term use of epoetinalpha 100 U/kg for 14 days resulted no response to treatment in 18 children with different types of cancer.…”

“…Leon et al [13] administered epoetin-alpha 150 U/kg 5 times a week for 3 months and achieved 72% response rate in 25 children with different solid tumors. Varan et al [11] also recommended to use epoetinalpha (without iron supplement) 150 U/kg thrice weekly for 2 months in patients with solid tumors. In our study 41 patients with either hematologic malignancy (21 patients) or solid tumor (14 patients) responded to epoetinalpha administration, since their Hb levels increased significantly by the 2nd and 3rd months and red cell transfusion requirement decreased by the 3rd month of therapy.…”

“…Many studies on adult patients with malignancy have shown that correction of anemia with recombinant human erythropoietin is related with increased hemoglobin (Hb) levels and increased quality of life [4][5][6][7]. There are a few studies that have investigated the role of erythropoietin in children with malignancy [8][9][10][11][12][13]. Nevertheless, most of the published studies enrolled patients predominantly in solid tumors.…”

Erythropoietin Use in Pediatric Oncology

“…29 Both groups were also treated with multiple cycles of platinum-and non-platinum-based chemotherapy. No one received iron therapy or G-CSF.…”

“…[25][26][27][29][30][31] Sequential improvement in the hemoglobin was shown in two of the trial groups, indicating that a response to EPO therapy may take several weeks to achieve. One study demonstrated decreased platelet transfusion requirements in the EPO-treated group.…”