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Post-Transplant Events

rHuEpo before high-dose therapy allows autologous peripheral stem-cell transplantation without red blood cell transfusion: a pilot study

Bone Marrow Transplantation volume 35, pages 903–907 (2005)Cite this article

Summary:

To decrease red blood cell (RBC) transfusion requirements during high-dose therapy (HDT) for hematological malignancies, we conducted a pilot study to assess the effect of recombinant human erythropoietin (rHuEpo) given during chemotherapy before HDT and autologous peripheral stem-cell transplantation (APSCT). The transfusion histories of 15 HDT and APSCT for hematological disease performed in 11 consecutive patients who received rHuEpo (10 000 U subcutaneously three times/week) were compared to those of 22 HDT and ASCT performed in 17 consecutive historical controls matched for hematological parameters. rHuEpo increased the hemoglobin (Hb) level from 10.3±2.3 g/dl at diagnosis to 12.9±2.2 g/dl at the time of HDT in 11 patients; no major adverse effects occurred. Compared to historical controls (95%, 21/22), RBC transfusion requirements were significantly lower for rHuEpo recipients (26%, 4/15) (P=0.00001) and rHuEpo responders (15%, 2/13) (P=0.000002). After HDT and APSCT, fewer RBC transfusions were needed: 3.3, 1.2 and 0.3 RBC units for controls, rHuEpo recipients and rHuEpo responders, respectively (P=0.006 and 0.00002). Therefore, rHuEpo should be administered before, and not after HDT and APSCT, to lower RBC transfusion requirements after HDT and APSCT.

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References

  1. Osterborg A, Brandberg Y, Molostova V et al. Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin beta, in hematologic malignancies. J Clin Oncol 2002; 20: 2486–2494.

    Article  CAS  PubMed  Google Scholar 

  2. Link H, Boogaerts MA, Fauser AA et al. A controlled trial of recombinant human erythropoietin after bone marrow transplantation. Blood 1994; 84: 3327–3335.

    CAS  PubMed  Google Scholar 

  3. Locatelli F, Zecca M, Pedrazzoli P et al. Use of recombinant human erythropoietin after bone marrow transplantation in pediatric patients with acute leukemia: effect on erythroid repopulation in autologous versus allogeneic transplants. Bone Marrow Transplant 1994; 13: 403–410.

    CAS  PubMed  Google Scholar 

  4. Vannucchi AM, Bosi A, Ieri A et al. Combination therapy with G-CSF and erythropoietin after autologous bone marrow transplantation for lymphoid malignancies: a randomized trial. Bone Marrow Transplant 1996; 17: 527–531.

    CAS  PubMed  Google Scholar 

  5. Chao NJ, Schriber JR, Long GD et al. A randomized study of erythropoietin and granulocyte colony-stimulating factor (G-CSF) versus placebo and G-CSF for patients with Hodgkin's and non-Hodgkin's lymphoma undergoing autologous bone marrow transplantation. Blood 1994; 83: 2823–2828.

    CAS  PubMed  Google Scholar 

  6. Ayash LJ, Elias A, Hunt M et al. Recombinant human erythropoietin for the treatment of the anaemia associated with autologous bone marrow transplantation. Br J Haematol 1994; 87: 153–161.

    Article  CAS  PubMed  Google Scholar 

  7. Pene R, Appelbaum FR, Fisher L et al. Use of granulocyte–macrophage colony-stimulating factor and erythropoietin in combination after autologous marrow transplantation. Bone Marrow Transplant 1993; 11: 219–222.

    CAS  PubMed  Google Scholar 

  8. Barlogie B, Smith L, Alexanian R . Effective treatment of advanced multiple myeloma refractory to alkylating agents. N Engl J Med 1984; 310: 1353–1356.

    Article  CAS  PubMed  Google Scholar 

  9. Rodriguez MA, Cabanillas FC, Velasquez W et al. Results of a salvage treatment program for relapsing lymphoma: MINE consolidated with ESHAP. J Clin Oncol 1995; 13: 1734–1741.

    Article  CAS  PubMed  Google Scholar 

  10. Colombat P, Biron P, Laporte JP et al. BEAM protocol and autologous bone marrow transplantation in first chemosensitive relapse of non-Hodgkin's lymphomas. Eur J Cancer 1990; 26: 858.

    Article  CAS  PubMed  Google Scholar 

  11. Tourani JM, Levy R, Colonna P et al. High-dose salvage chemotherapy without bone marrow transplantation for adult patients with refractory Hodgkin's disease. J Clin Oncol 1992; 10: 1086–1094.

    Article  CAS  PubMed  Google Scholar 

  12. Klaesson S, Ringden O, Ljungman P et al. Reduced blood transfusion requirements after allogeneic bone marrow transplantation: results of a randomised, double-blind study with high-dose erythropoietin. Bone Marrow Transplant 1994; 13: 397–402.

    CAS  PubMed  Google Scholar 

  13. Biggs JC, Atkinson KA, Booker V et al. Prospective randomised double-blind trial of the in vivo use of recombinant human erythropoietin in bone marrow transplantation from HLA-identical sibling donors. The Australian Bone Marrow Transplant Study Group. Bone Marrow Transplant 1995; 15: 129–134.

    CAS  PubMed  Google Scholar 

  14. Steegmann JL, Lopez J, Otero MJ et al. Erythropoietin treatment in allogeneic BMT accelerates erythroid reconstitution: results of a prospective controlled randomized trial. Bone Marrow Transplant 1992; 10: 541–546.

    CAS  PubMed  Google Scholar 

  15. Vannucchi AM, Bosi A, Linari S et al. High doses of recombinant human erythropoietin fail to accelerate platelet reconstitution in allogeneic bone marrow transplantation. Results of a pilot study. Haematologica 1997; 82: 53–56.

    CAS  PubMed  Google Scholar 

  16. Link H, Brune T, Hubner G et al. Effect of recombinant human erythropoietin after allogenic bone marrow transplantation. Ann Hematol 1993; 67: 169–173.

    Article  CAS  PubMed  Google Scholar 

  17. Miller C, Dempsey H, Weiner R et al. Recombinant human erythropoietin (rHuEpo) does not promote ‘stem-cell steal’ following autologous bone marrow transplant. Blood 1993; 82: 638a.

    Google Scholar 

  18. Waller CF, von Lintig F, Daskalakis A et al. Mobilization of peripheral blood progenitor cells in patients with breast cancer: a prospective randomized trial comparing rhG-CSF with the combination of rhG-CSF plus rhEpo after VIP-E chemotherapy. Bone Marrow Transplant 1999; 24: 19–24.

    Article  CAS  PubMed  Google Scholar 

  19. Ponchio L, Zambelli A, De Stefano A et al. Transfusion requirement can be abolished by epoietin-alpha and autologous platelet predeposit in patients receiving high dose chemotherapy with stem cell support. Haematologica 2000; 85: 219–220.

    CAS  PubMed  Google Scholar 

  20. Baron F, Frère P, Fillet G, Beguin Y . Tandem high-dose therapy (HDT) for multiple myeloma: recombinant human erythropoietin therapy given between first and second HDT allows second peripheral blood stem cell transplantation without red blood cell transfusion. Br J Haematol 2003; 123: 103–105.

    Article  CAS  PubMed  Google Scholar 

  21. Miller CB, Jones RJ, Zahurak ML et al. Impaired erythropoietin response to anemia after bone marrow transplantation. Blood 1992; 80: 2677–2682.

    CAS  PubMed  Google Scholar 

  22. Vannucchi AM, Grossi A, Bosi A et al. Impaired erythropoietin production in mice treated with cyclosporin A. Blood 1991; 78: 1615–1618.

    CAS  PubMed  Google Scholar 

  23. Faquin WC, Schneider TJ, Goldberg MA . Effect of inflammatory cytokines on hypoxia-induced erythropoietin production. Blood 1992; 79: 1987–1994.

    CAS  PubMed  Google Scholar 

  24. Johnson CS, Cook CA, Furmanski P . In vivo suppression of erythropoiesis by tumor necrosis factor-alpha (TNF-alpha): reversal with exogenous erythropoietin (EPO). Exp Hematol 1990; 18: 109–113.

    CAS  PubMed  Google Scholar 

  25. Salmonson T, Danielson BG, Wikstrom B . The pharmacokinetics of recombinant human erythropoietin after intravenous and subcutaneous administration to healthy subjects. Br J Clin Pharmacol 1990; 29: 709–713.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Zachee P . Controversies in selection of epoetin dosages. Issues and answers. Drugs 1995; 49: 536–547.

    Article  CAS  PubMed  Google Scholar 

  27. Koury MJ, Sawyer ST, Brandt SJ . New insights into erythropoiesis. Curr Opin Hematol 2002; 9: 93–100.

    Article  PubMed  Google Scholar 

  28. Zermati Y, Garrido C, Amsellem S et al. Caspase activation is required for terminal erythroid differentiation. J Exp Med 2001; 193: 247–254.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Beguin Y . Prediction of response to treatment with recombinant human erythropoietin in anaemia associated with cancer. Med Oncol 1998; 15 (Suppl. 1): S38–S46.

    PubMed  Google Scholar 

  30. Littlewood TJ, Bajetta E, Nortier JW et al. Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 2001; 19: 2865–2874.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Janet Jacobson for editorial assistance.

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Authors and Affiliations

  1. Blood Disease Department, University Hospital, Angers, France

    M Hunault-Berger, A Tanguy-Schmidt, P Rachieru, M Truchan-Graczyk, S Francois, M Gardembas-Pain, M Dib, C Foussard & N Ifrah

  2. DBIM and INSERMU444, Hôpital Saint Louis, Paris, France

    V Lévy

  3. Etablissement Français du Sang, Angers, France

    N Piard

  4. Hematology Laboratory, University Hospital, Angers, France

    A Godon

  5. Centre Jean-Bernard, Le Mans, France

    P Solal-Celigny

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  1. M Hunault-Berger
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Correspondence to N Ifrah.

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Hunault-Berger, M., Tanguy-Schmidt, A., Rachieru, P. et al. rHuEpo before high-dose therapy allows autologous peripheral stem-cell transplantation without red blood cell transfusion: a pilot study. Bone Marrow Transplant 35, 903–907 (2005). https://doi.org/10.1038/sj.bmt.1704899

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