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REPLY
Predicting Response to Recombinant Human Erythropoietin
Robert I. Abels, MD, and
David H. Henry, MD
1 July 1993 | Volume 119 Issue 1 | Pages 91-92
IN RESPONSE:
In order to limit r-HuEPO therapy to patients most likely to respond, Drs. Mittelman and Floru suggest that it be restricted to patients with low serum erythropoietin levels. Although patients with low serum erythropoietin levels frequently respond more vigorously to r-HuEPO than do patients with higher levels, this is not always the case. In addition, it is often difficult to stipulate a serum erythropoietin level above which r-HuEPO therapy should be withheld.
Further analysis of our data [1] suggests that patients with serum erythropoietin levels between 100 and 500 IU/L had a response to r-HuEPO that was similar to that of patients whose serum erythropoietin levels were less than 100 IU/L (Table 1). Consequently, we continue to believe that in anemic patients with AIDS who are receiving zidovudine, a serum erythropoietin level 
500 IU/L is a reasonably good predictor of response to r-HuEPO. However, it is not a value above which r-HuEPO is necessarily ineffective. We have not found a statistically significant relation between baseline erythropoietin levels and response to r-HuEPO in anemic patients with cancer who are receiving concomitant chemotherapy [2]. In addition, some patients with myelodysplasia who have serum EPO levels 
500 IU/L may respond to pharmacologic doses of r-HuEPO [3].
We agree with Drs. Mittelman and Floru that it is important to try to limit r-HuEPO therapy to patients who are likely to respond. Although the predictive value of the baseline serum erythropoietin level in other anemic populations still must be defined, it may be prudent to avoid r-HuEPO therapy in patients with grossly elevated serum erythropoietin levels.
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Author and Article Information
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The R.W. Johnson Pharmaceutical Research Institute; Raritan, NJ 08869
Graduate Hospital, Philadelphia, PA 19146
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. Abels R, Larholt K, Krantz K, Bryant E. Recombinant human erythropoietin (r-HuEPO) for the treatment of the anemia of cancer. Proceedings of the Beijing Symposium. In: Murphy MJ; ed. Blood Cell Growth Factors: Their Present and Future Use in Hematology and Oncology. Dayton, Ohio: Alpha Medical Press; 1991:121-41.
3. Stein R, Abels R, Krantz S. Pharmacologic doses of recombinant human erythropoietin in the treatment of myelodysplastic syndromes. Blood. 1991; 78:1658-63.
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