RECOMBINANT ERYTHROPOIETIN TRIAL IN CHILDREN WITH TRANSFUSION-DEPENDENT HOMOZYGOUS BETA-THALASSEMIA

Augmentation of gamma-gene synthesis by using recombinant human erythr opoietin (r-Hu-EPO) represents a new approach to the therapy of beta-t halassemia. A prospective study was conducted in 26 transfusion-depend ent beta-thalassemia major patients. r-Hu-EPO (Eprex/Cilag, Switzerlan d) was given to the patients at an initial dose of 500 IU/kg s.c. 3 ti mes a week for at least 2 months during which no transfusion was appli ed. A sustained hemoglobin (Hb) level greater than 8 g/dl was consider ed as a response to EPO treatment. In the patients whose Hb levels rem ained under 8 g/dl or did not increase in comparison to pretreatment l evels within 4 weeks, the dose of r-Hu-EPO was increased to 1,000 IU/k g 3 times a week and applied for another 4 weeks. Only 16 cases also r eceived oral iron supplementation. The whole blood and reticulocyte co unts, the biochemical tests including BUN, creatinine, AST, ALT, alkal ine phosphatase and ferritin were done and the percentages of HbF and F cells were analyzed regularly. At the end of the 2nd month, 6 cases qualified to continue with the trial. At the end of the 6th month, r-H u-EPO therapy was ceased in 3 cases of the 6 since their Hb levels had decreased below 7 g/dl. Only 3 cases (11.5%) continued with the r-Hu- EPO therapy without transfusion for up to 12 months. In conclusion, r- Hu-EPO may be useful in some selected transfusion-dependent patients w ith beta-thalassemia major. Selection criteria should include a mild b eta-genotype or coinheritance of alpha-thalassemia, splenectomy and pr etreatment reticulocyte response of the patients as well as the patien ts' compliance.