Recombinant human erythropoietin treatment for chemotherapy-related anemiain children

Objective. The efficacy and safety of recombinant human erythropoietin (rHu EPO) treatment in chemotherapy-induced anemia in children were investigated , rHuEPO is used to treat chemotherapy-induced anemia. Several studies reco mmend 150 to 300 IU/kg rHuEPO for 2 to 8 months. There are only a few contr olled trials in children and no precise data about the optimal dose and dur ation of rHuEPO treatment is available. Patients and Methods. Thirty-four patients receiving chemotherapy for treat ment of their solid tumors between October 1996 and June 1997 were included in this study. Patients were randomly selected for each group. The male/fe male ratio was 20/14, and the median age was 5 years (range, 1-16 years). T hey had normal hemoglobin levels at the time of diagnosis. When hemoglobin levels decreased to levels lower than 10 g/dL, rHuEPO (150 IU/kg/d, 3 times a week, subcutaneously) was given to 17 patients for 2 months. Their renal , liver, and pulmonary functions were normal. None of the patients had hema tologic disease. We did not use any other drugs such as iron or granulocyte colony-stimulating factor. There were 17 patients in the control group. Fi fteen patients got chemotherapy regimens including cisplatin (CDDP), but 19 were treated with regimens without CDDP. At the end of rHuEPO treatment, a ll patients were examined in terms of transfusion requirements and rate of change in hemoglobin levels. Results. One patient in the study group needed a blood transfusion, whereas 8 patients needed a transfusion in the control group. Patients in the stud y group had less transfusion requirements compared with the control group. The mean hemoglobin levels before and after the study were 8.48 +/- 0.98 g/ dL and 8.41 +/- 1.65 g/dL in the control group and 8.50 +/- 0.85 g/dL and 1 0.21 +/- 2.14 g/dL in the rHuEPO group, respectively. Optimal hemoglobin in crements began in 4 weeks and continued during treatment. CDDP-receiving an d CDDP-nonreceiving groups did not have any difference in pretreatment seru m erythropoietin levels. rHuEPO treatment was more effective in patients tr eated with non-CDDP regimens. Mean hemoglobin level increased from 8.68 +/- 0.73 g/dL to 10.26 +/- 1.84 g/dL in 9 patients treated with non-CDDP chemo therapy regimens in the erythropoietin group, although it increased from 8. 28 +/- 0.97 g/dL to 10.15 +/- 2.5 g/dL in 8 patients treated with CDDP-cont aining regimens in the erythropoietin group. rHuEPO caused high blood press ure in only 1 patient that resolved spontaneously after cessation of erythr opoietin treatment for a week. Conclusion. rHuEPO treatment (150 IU/kg/d 3 times a week) is effective and safe in children with chemotherapy-induced anemia. It decreases blood trans fusion requirements in solid tumor patients. Our results show that the resp onse to rHuEPO in CDDP-induced anemia is less than the response in non-CDDP receiving patients. Higher doses may be necessary in patients using CDDP.