Anemia is a common complication in patients with
multiple myeloma (MM) and occurs in more than two thirds of all patients. The most frequent underlying pathophysiological mechanism is
anemia of
chronic disease (ACD), relative
erythropoietin (EPO) deficiency (due partly to renal impairment) and myelosuppressive effects of
chemotherapy, but many other factors may account for or contribute to
anemia in myeloma. In patients who achieve complete remission after
chemotherapy,
anemia usually normalizes. Nonresponders and relapsing myeloma patients often continue to suffer from
anemia. Treatment options for anemic myeloma patients include red blood cell (RBC) transfusions and recombinant human
erythropoietin (rHuEPO).
Red blood cell transfusions convey an immediate effect and rapidly increase the patient's
hemoglobin level. Unfortunately, effects of RBC transfusions are only transient and can be associated with several risks, including
infections and mild to even life-threatening immunologic reactions. rHuEPO is biologically equivalent to the human endogenous
hormone EPO, and its application leads to an increase of
hemoglobin levels over an extended time without the risks of
blood transfusions. Several studies reported a significant improvement of erythropoiesis, reduction in transfusion need, and improved quality of life by using rHuEPO as long-term treatment of myeloma-associated
anemia. Recently, an international expert panel recommended the use of rHuEPO for anemic myeloma patients where other possible causes of
anemia have been eliminated.