Use of Recombinant Human Erythropoietin Outside the Setting of Uremia

Cazzola, Mario; Mercuriali, F.; Brugnara, Carlo

doi:10.1182/blood.v89.12.4248

Cited by 230 publications

(101 citation statements)

References 139 publications

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“…4 Endogenous erythropoietin (EPO) is mostly produced in the kidney by stimulation such as hypoxia, which is the fundamental physiological stimulus for EPO production through a rapid increase in the number of renal EPO-producing cells. 5 Impairment of EPO production is a major cause of anaemia in HF patients with renal insufficiency; therefore, EPO has been expected to be reduced in the cardio-renal-anaemia syndrome. In contrast, several previous studies revealed that an elevated EPO level was frequently observed and was associated with impaired survival, independent of anaemia and renal function, in chronic HF patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of endogenous erythropoietin in long‐term outcome of patients with acute decompensated heart failure

Nagai

Nishimura

Honma

et al. 2016

European J of Heart Fail

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AimsAlthough previous reports suggest that an elevated endogenous erythropoietin (EPO) level is associated with worse clinical outcomes in chronic heart failure (HF) patients, the prognostic implication of EPO in patients with acute decompensated HF (ADHF) Methods and resultsWe examined 539 consecutive ADHF patients with EPO measurement on admission from our registry. During a median follow-up period of 329 days, a higher EPO level on admission was independently associated with worse clinical outcomes [hazard ratio (HR) 1.25, 95% confidence interval (CI) 1.06-1.48, P = 0.008], and haemoglobin level was the strongest determinant of EPO level (P < 0.001), whereas estimated glomerular filtration rate (eGFR) was not significant in multivariate regression analysis. In the anaemic subgroup of 318 patients, a higher EPO level than expected on the basis of their haemoglobin level was related to increased adverse events (HR 1.63, 95% CI 1.05-2.49, P = 0.028). Moreover, estimated plasma volume excess rate was positively associated with EPO level (P = 0.003), and anaemic patients with a higher than expected EPO level tended to have a higher estimated plasma volume excess rate and plasma lactate level, and lower systemic oxygen saturation level with the preservation of the reticulocyte production index than those with a lower than expected EPO level.

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Section: Introductionmentioning

confidence: 99%

Prognostic significance of endogenous erythropoietin in long‐term outcome of patients with acute decompensated heart failure

Nagai

Nishimura

Honma

et al. 2016

European J of Heart Fail

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“…FID; (ii) intrinsic unresponsiveness of the bone marrow. Laboratory tests designed to predict intrinsic unresponsiveness and FID have been recommended [13]. The simplest indicator of intrinsic unresponsiveness is a deficient increase in serum haemoglobin ( < 1 g/dL at 4-8 weeks after starting rHuEPO therapy).…”

Section: Prediction Of Response To Rhuepo In Patients With a Criticalmentioning

confidence: 99%

“…The simplest indicator of intrinsic unresponsiveness is a deficient increase in serum haemoglobin ( < 1 g/dL at 4-8 weeks after starting rHuEPO therapy). FID is monitored by transferrin saturation (TfS) and a value of < 20% indicates FID, but TfS is not a reliable marker in the critically ill [13]. Until now no tests have been evaluated for differentiating between intrinsic unresponsiveness of the marrow and progression of FID in the critically ill, and in ACD in real time.…”

Section: Prediction Of Response To Rhuepo In Patients With a Criticalmentioning

confidence: 99%

Anaemia in the critically ill patient: monitoring of erythropoietin therapy

Thomas¹,

Wiesner²,

Melchior³

et al. 2006

BJU International

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“…Because of the low toxicity of the drug, the main obstacle to its use in the clinical setting remains the economic costs. In uremic patients, erythropoietin has been shown to be cost effective only at a weekly maintenance dose of less than 100 U/kg body weight when compared to a regular transfusion requirement of two to three units of blood per month [23]. In cancer patients erythropoietin is generally given at the dose of 150 U/kg three times a week.…”

Section: Commentsmentioning

confidence: 99%

Strategies for the Use of Epoetin Alfa in Breast Cancer Patients

Mastro

Venturini

1998

The Oncologist

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Anemia is a common complication in cancer patients undergoing chemotherapy, and its severity depends on both the type of antineoplastic drugs and the clinical status of the patient. Breast cancer patients undergoing standard chemotherapy develop clinically significant anemia in up to 25% of cases. This percentage, moreover, increases up to 63% when more intensive chemotherapy regimens are used. The therapeutic use of erythropoietin in anemic patients, i.e., in patients with hemoglobin levels below 9‐10.5 g/dl, is able to correct the anemic status in nearly 40%‐80% of such patients, but it does not completely eliminate the need of blood transfusions: 20%‐40% of patients need to be transfused despite the erythropoietin treatment. An alternative strategy for optimizing the erythropoietin treatment is its use in the prevention of anemia, i.e., in patients with normal hemoglobin values but at high risk of becoming anemic. In a phase III study, we evaluated the role of erythropoietin in the prevention of anemia in breast cancer patients undergoing dose‐intensive chemotherapy. Clinically significant anemia occurred in 52% (95% CI = 33‐69) of control patients and in no patient (95% CI = 0‐14) in the erythopoietin arm (p = .00001). After six cycles of chemotherapy the mean hemoglobin decrease was 3.05 g/dl (± 1.0, 95% CI = 2.6‐3.5) in the control arm and 0.8 g/dl (± 1.4, 95% CI = 0.3‐1.4) in the erythropoietin arm. Moreover, 6.4% of control patients needed blood transfusion compared to no patients in the erythropoietin arm. Erythropoietin is active in both the treatment and the prevention of anemia in cancer patients undergoing chemotherapy. Due to its high economic cost, efforts should be made to identify subsets of patients in whom the preventive use could be cost‐effective. Patients undergoing chemotherapy associated with a high risk of anemia could benefit from preventive use of erythropoietin in special circumstances, such as presence of risk of myocardial or cerebral ischemia, uncommon blood group, or religious beliefs hindering blood transfusions. Moreover, anemia prevention could be considered in patients at high risk of requiring blood transfusions, such as patients with low baseline value of hemoglobin or with a hemoglobin decrease of ≥2 g/dl after the first cycle of chemotherapy.

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Use of Recombinant Human Erythropoietin Outside the Setting of Uremia

Cited by 230 publications

References 139 publications

Prognostic significance of endogenous erythropoietin in long‐term outcome of patients with acute decompensated heart failure

Prognostic significance of endogenous erythropoietin in long‐term outcome of patients with acute decompensated heart failure

Anaemia in the critically ill patient: monitoring of erythropoietin therapy

Strategies for the Use of Epoetin Alfa in Breast Cancer Patients

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