RECOMBINANT-HUMAN-ERYTHROPOIETIN FOR THE TREATMENT OF CHRONIC ANEMIA IN MULTIPLE-MYELOMA AND SQUAMOUS-CELL CARCINOMA

Recombinant human erythropoietin (rHuEPO) improves chronic anemia of c ancer, but the proportion of patients who respond favorably to the tre atment varies depending on the type of neoplasia. Preliminary data of the two malignancies with the highest response rates, namely, multiple myeloma and squamous cell carcinoma, are reported. Twenty patients wi th multiple myeloma and 14 with squamous cell carcinoma, who had prese nted with hemoglobin levels <11 g/dl, were treated with rHuEPO, 150 U/ kg, three times/week. Response, defined as an increase of at least 2 g /dl hemoglobin within 12 weeks, was achieved by 15 myeloma patients (7 5%) and 11 patients with squamous cell carcinoma (79%). Tolerance of t he treatment was excellent. The WHO performance status and quality of life improved in responders. The remarkably low levels of endogenous E PO in our patients with squamous cell carcinoma, most of whom had been treated with cisplatin-or carboplatin-containing regimens, suggest th at anemia in these cases had been at least partly chemotherapy induced . In myeloma patients, the blunted EPO response to the anemic conditio n may have been partly caused by subclinical tubular insufficiency ind uced by toxic paraproteins. Future studies should aim to elucidate fac tors which are responsible for the inability of some patients to respo nd to rHuEPO treatment, even though in multiple myeloma and squamous c ell carcinoma these non-responders are a small minority.