Epoetin alpha in multiple myeloma: literature review and our own experience

Background. Anemia is the main symptom of multiple myeloma (MM) both at the time of disease onset and during tumor progression. Previously, the main method of anemia treatment was blood transfusion therapy. Currently, blood transfusions are supplemented by erythropoietin (EPO) administration. Safety and effectiveness of the drug have been proven in multiple trials including trials involving oncohematological patients.

Aim. To present the results of using epoetin alpha (Eralfon) in patients with MM complicated by dialysis-dependent myeloma cast nephropathy in real clinical practice; to analyze the literature data on the use of EPO for the treatment of anemia in MM patients.

Materials and methods. A retrospective analysis of a series of clinical observations was carried out: 4 patients with newly diagnosed MM at the ages between 52 and 60 years who underwent treatment at the Department of Hematology and Chemotherapy of Paraproteinemic Hemablastoses with a Bone Marrow and Hematopoietic Stem Cell Transplantation Block. All patients were diagnosed with myeloma cast nephropathy with significantly decreased glomerular filtration rate of 7–15 mL/min requiring renal replacement therapy. At the time of disease diagnosis, median hemoglobin level was 75 g/L, median creatinine level was 517.5 µmole/L. Endogenous EPO level was measured in all patients prior to epoetin alpha prescription: it varied between 2.31 and 149.6 IU/mL. Epoetin alpha (Eralfon) was prescribed at dose 12 000 IU – 0.3 mL subcutaneously 3 times a week. A review of the literature data on the use of EPO in patients with MM was conducted.

Results. All patients at MM onset were dependent on renal replacement therapy and blood transfusion, therefore epoetin alpha was prescribed immediately. In case of renal function recovery and end of dialysis at target hemoglobin levels, administration of the drug was ceased. If dependence on renal replacement therapy persisted, epoetin alpha treatment continued as synthetic function of EPO-producing cells was compromised. In all clinical cases, epoetin alpha therapy was effective.

Conclusion. Clot formation prevention should be kept in mind during epoetin alpha therapy. Decreased requirement for blood transfusions, improved quality of life with favorable safety profile of the drug make epoetin alpha an indispensable part of accompanying therapy in patients with MM and anemia.

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