THE USE OF ERYTHROPOIETIN IN THE TREATMENT OF POST-BONE MARROW TRANSPLANTATION ANEMIA

The issue of the role of erythropoietin (Epo) in the erythroid reconst itution after bone marrow transplantation (BMT) has been addressed in several recent studies. A defective Epo production in response to anem ia has been shown to occur in patients undergoing allogeneic BMT unlik e in most of those subjected to an autologous rescue. The factors invo lved in the inadequate Epo production in BMT are discussed, with parti cular attention to the role of the immunosuppressive drug cyclosporin- A, which has been shown to inhibit Epo production in both in vivo and in vitro models. The observation of defective Epo production eventuall y led to the development of clinical trials of recombinant human Epo ( rhEpo) administration in BMT patients; the aims of these studies were to stimulate erythroid engraftment, hence reducing blood transfusion e xposure. Although the number of patients studied up to now is relative ly small, a benefit from rhEpo administration in terms of accelerated erythroid engraftment seems very likely, and it may also be associated with decreased transfusional needs in most treated patients. However, further studies are needed to better define indications, dosages and schedules of rhEpo in BMT patients.