THERAPY OF ANEMIA IN PATIENTS WITH MULTIPLE-MYELOMA

Multiple myeloma is very frequently associated with anemia which has t he character of hypoproliferative anemia of chronic diseases. In this type of anemia there is often insufficient production of endogenous er ythropoietin. According to literature pharmacological doses of erythro poietin result in the increase of blood hemoglobin concentration. Eryt hropoietin (Eprex Cilag(R)) was given to 11 patients whose hemoglobin concentration in blood was lower than 100 g/l. 10 patients could be ev aluated at the end of the study. Within the first month all patients w ere given erythropoietin in the dose of 150 U/kg 3 times a week. The d ose was doubled, when the blood hemoglobin concentration did not incre ase by more than 10 g/l within the first month. In patients with hemog lobin level above 120 g/l we were trying to find the individual mainte nance dose. In patients who had not reached a blood hemoglobin concent ration increase of at least 20 g/l, as compared with the initial level , further erythropoietin administration was stopped. The concentration of hemoglobin increased of 20 g/l in 8 (80%) out of 10 patients evalu ated. All 5 patients who responded within the first month, had had pre treatment concentration of endogenous erythropoietin below 60 U/l. Thr ee other patients had not been responding before their dose of erythro poietin was increased in the 2nd and 3rd months of therapy. The therap y response appeared only in the 2nd and the 3rd months of treatment. T hese 3 patients had higher pretreatment concentrations of endogenous e rythropoietin, from 100 to 350 U/l. During the treatment no adverse ef fects of erythropoietin were observed. Erythropoietin is a useful drug for anemic patients with the diagnosis of multiple myeloma. According to the results mentioned above and also according to the data from li terature it is evident that in patients with the endogenous blood eryt hropoietin value below 100 U/l it is possible to expect a sudden rise in hemoglobin concentration already within the first month. Patients w ith a higher concentration of endogenous erythropoietin (100 to 500 U/ l) respond to the therapy less frequently and for the increase in hemo globin it is necessary to give higher-doses of erythropoietin. Patient s with the initial value of erythropoietin above 500 U/l are not likel y to respond.