Erythropoietin Response to Anemia Is Impaired in Patients with Hematologic Malignancies.

Anemia is a common complication in patients with hematologic malignancies, either before or after chemotherapy. To find out whether anemic patients with hematologic malignancies have a lower erythropoietin (Epo) response, we analyzed serum Epo levels in these patients. Serum samples for measurement of Epo levels were obtained from 80 patients from three medical centers. Patients had multiple myeloma (MM, n=26), chronic lymphocytic leukemia (CLL, n=6) or non-Hodgkin’s lymphoma (NHL, n=48). Thirty patients had anemia (mean hemoglobin [Hb] level 8.4±1.6 g/dl) and 50 patients were not classed as anemic, with mean Hb levels of 12.7±1.4 g/dl. To provide control values, serum Epo levels were also determined in patients with iron-deficiency anemia (IDA; n=20) and in healthy individuals (n=20). Serum Epo levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients with severe liver or renal dysfunction, low platelet counts or blood loss were excluded. The complete blood cell count (CBC), reticulocyte count, serum lactate dehydrogenase (LDH), liver and renal function, serum iron (SI), total iron-binding capacity (TIBC), transferrin saturation (TSAT), and serum ferritin (SF) levels were evaluated concomitantly. There were no significant differences in CBC, LDH, liver and renal function, SI, TIBC, TSAT and SF values between malignant patients with or without anemia (P>0.05). In patients with hematologic malignancy, those with anemia had higher Epo levels (mean 97.8±183.9 mIU/ml) than those without anaemia (mean 27.8±85.4 mIU/ml; P<0.001). In patients with IDA, the Epo response was inversely correlated with Hb level (r= −0.5, P<0.05), whereas the expected inverse linear relationship between serum levels of Epo and Hb was absent in the group with hematologic malignancies (r= −0.14). Anemic patients with malignancy, and IDA patients both had elevated Epo levels compared with normal controls (means, 97.8±183.9 mIU/ml, 158.3±308.6 mIU/ml and 9.2±4.0 mIU/ml, respectively; both P<0.001 vs controls). However, after correcting for Hb level, anemic patients with malignancy were found to have significantly lower Epo levels than patients with IDA (P=0.032) indicating a decreased Epo response in the former group. These findings indicate that anemia associated with hematologic malignancy may result from an inappropriately low Epo response. Epo treatment should benefit this group of patients.