Prognostic value of serum erythropoietin in the correction of anemia using recombinant erythropoietin drugs in patients with lymphoproliferative diseases

Aim. To evaluate the prognostic significance of the baseline content of endogenous erythropoietin in the blood serum of patients with lymphoproliferative diseases while using recombinant erythropoietin drugs to correct the anemia.Methods. 69 patients with lymphoproliferative disorders (chronic lymphocytic leukemia, indolent forms of non-Hodgkins lymphoma and multiple myeloma) in combination with anemia, ages from 24 to 81 years, were under our observation. Treatment with recombinant erythropoietin was performed in the first group (48 patients), the second (control) group consisted of 21 patients without treatment with recombinant erythropoietin. In all patients the hemoglobin concentration was reduced to 37-100 g/l.Results. A positive response to treatment with recombinant erythropoietin for 6-16 weeks was noted in 30 out of 48 patients treated with epoetin alfa (62.5%, p 0.05). The monthly increase in hemoglobin level was 19.1±14.4 g/l, while in patients who were not responding to therapy - 2.1±4.3 g/l. In the control group of patients not receiving recombinant erythropoietin drugs the monthly increase in hemoglobin level was 2.0±4.4 g/l, which is the same as in the group who did not respond to recombinant erythropoietin and is significantly lower (p 0.01), than in patients with a positive response. In the control group, the increase in hemoglobin level 20 g/l during 20 weeks was observed only in 5 of 21 (23.4%) patients. A reduced level of endogenous erythropoietin was detected in 28 (58.3%) patients, while increased and correlating with the severity of anemia was detected in 20 (41.7%) patients. An inverse correlation was established between the positive response to treatment with recombinant erythropoietin and the baseline endogenous erythropoietin (r=-0.36, n=48, p 0,05). The positive effect of epoetin alfa was observed more frequently in patients with low serum erythropoietin level [22 of 28 (78.6%) patients responded, p 0.01], than in patients with high erythropoietin level [only 8 out of 20 (40%) patients responded to treatment, p 0.05].Conclusion. Low concentration of endogenous erythropoietin suggests a positive response to recombinant erythropoietin products and can therefore be used as one of the predictors of response; in cases of high (above 500 mIU/ml) levels of endogenous erythropoietin the response occurs very rarely; an intermediate level of erythropoietin (130-500 mIU/ml) may also be justified for the administration of recombinant erythropoietin.