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Prediction of response to erythropoietin treatment in chronic anemia of
cancer [see comments]
H Ludwig, E Fritz, C Leitgeb, M Pecherstorfer, H Samonigg and J Schuster
First Department of Medicine and Medical Oncology, Wilhelminenspital,
Vienna, Austria.
Chronic anemia of cancer can be corrected in approximately 50% of the cases
by treatment with recombinant human erythropoietin (rHuEPO). Early
prediction of responsiveness would avoid the emotional and financial burden
of ineffective medical intervention. Eighty patients with chronic anemia of
cancer undergoing treatment with rHuEPO (150 U/kg, 3 times per week by
subcutaneous injection; after 6 weeks without response, 300 U/kg)
participated in this study. Response was defined as a gain of at least 2
g/dL hemoglobin (Hb) within 12 weeks. Multivariate discriminant analysis
and logistic regression analysis of response were performed on routine
blood tests; serum levels of EPO, iron, ferritin, transferrin, and its
receptor; World Health Organization (WHO) performance status; various
cytokines; neopterin; stem cell factor; C- reactive protein; and alpha
1-antitrypsin. At baseline, none of these factors showed sufficient
prognostic power. The following predictive algorithm was developed: (1) If
after 2 weeks of therapy both the serum EPO level is > or = 100 mU/mL
and Hb concentration has not increased by at least 0.5 g/dL,
unresponsiveness of the patient is very likely (predictive power, 93%);
otherwise, response may be predicted with an accuracy of 80%. (2) If both
the serum level of EPO is less than 100 mU/mL and Hb concentration has
increased by > or = 0.5 g/dL, response is highly probable (predictive
power, 95%). (3) Alternatively, a serum ferritin level of > or = 400
ng/mL after 2 weeks of rHuEPO therapy strongly indicates unresponsiveness
(predictive power, 88%), whereas a level less than 400 ng/mL suggests
response in 3 of 4 patients.
Volume 84,
Issue 4,
pp. 1056-1063,
08/15/1994
Copyright © 1994 by The American Society of Hematology
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