LETTER
Predicting Response to Recombinant Human Erythropoietin
Moshe Mittelman, MD, and
Sharon Floru, MD
1 July 1993 | Volume 119 Issue 1 | Pages 91-92
TO THE EDITOR:
We read with interest the recent article by Henry and colleagues [1], summarizing four clinical trials of recombinant human erythropoietin (r-HuEPO). They conclude that therapy with r-HuEPO can increase the mean hematocrit value and decrease the mean transfusion requirement in anemic patients with the acquired immunodeficiency syndrome (AIDS) who are receiving zidovudine and have low endogenous erythropoietin levels (<500 IU/L).
Given the expanding indications for and the high price of r-HuEPO therapy, predicting the response to therapy is important. Response to r-HuEPO appears not to be related to age, gender, time since diagnosis, time since initiation of transfusion therapy, or changes in plasma transferrin receptor protein concentrations [2, 3].
We administered r-HuEPO therapy to seven anemic patients who had stem cell disorders with r-HuEPO and concluded that the pretreatment serum erythropoietin level was a good predictor of response [4]; other findings support this conclusion [5]. It also seems possible to use a lower pretreatment serum erythropoietin level (approximately 200 IU/L) as the cutoff point.
Thus, we believe that Henry and colleagues' data can be extended to other candidates for r-HuEPO therapy.
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Author and Article Information
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Hasharon Hospital, Tel Aviv University; Petah-Tikva 49372, Israel
1. Henry DH, Beall GN, Benson CA, Carey J, Cone LA, Eron LJ, et al. Recombinant human erythropoietin in the treatment of anemia associated with human immunodeficiency virus (HIV) infection and zidovudine therapy. Overview of four clinical trials. Ann Intern Med. 1992; 117:739-48.
2. Stein RS, Abels RI, Krantz SB. Pharmacologic doses of recombinant human erythropoietin in the treatment of myelodysplastic syndromes. Blood. 1991; 78:1658-63.
3. Adamson JW, Schuster M, Allen S, Haley NR. Effectiveness of recombinant human erythropoietin therapy in myelodysplastic syndromes. Acta Haematol. 1992; 87(Suppl 1):20-4.
4. Mittelman M, Floru S, Djaldetti M. Subcutaneous erythropoietin for treatment of refractory anemia in hematologic disorders (Letter). Blood. 1992; 80:841-3.
5. Cazzola M, Ponchio L, Beguin Y, Bergamaschi G, Liberato NL, Fregoni V, et al. Subcutaneous erythropoietin for treatment of refractory anemia in hematologic disorders. Results of a phase I/II clinical trial. Blood. 1992; 79:29-37.
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