PERISURGICAL ERYTHROPOIETIN APPLICATION IN ANEMIC PATIENTS WITH COLORECTAL-CANCER - A DOUBLE-BLIND RANDOMIZED STUDY

Background. Blood transfusions are associated with higher postoperativ e morbidity and tumor recurrence rates in colorectal cancer surgery. T o reduce the need for transfusions in patients with tumor-induced anem ia who are not suitable for autologous blood donation, it was tested w hether perisurgical erythropoietin application would be able to stimul ate hematopoiesis adequately. Methods. In a double-blind randomized st udy 150 IU/kg body weight erythropoietin was given subcutaneously ever y 2 days beginning 10 days before operation and continuing until posto perative day 2. Twenty patients were randomized into the erythropoieti n. group with three observed dropouts and 10 patients into the placebo group. Results. In the erythropoietin group two episodes of hypertens ion and one deep venous thrombosis were observed. Preoperative hemoglo bin response in the erythropoietin group (p = 0.069) was paralleled by a highly significant reticulocyte increase (p = 0.0004). However, fre quency of blood transfusion was not different between both study group s (erythropoietin, 1.82 +/- 0.80 units/patient; placebo, 1.80 +/- 0.97 units/patient). If iron. availability was analyzed, a strong correlat ion between ferritin blood levels and transferrin iron saturation with hemoglobin response was observed in regression analysis (p < 0.001). Conclusions. These results indicate that hematopoiesis in anemic patie nts with colorectal cancer can be stimulated by erythropoietin; howeve r, clinical efficacy is to be expected only in selected patients with high iron availability, which calls for further studies combining eryt hropoietin and parenteral iron application.