Inadequate erythropoietin production in allogeneic bone marrow transplant patients.

BACKGROUND. There is some evidence that the erythropoietin (Epo) feedback mechanism in response to anemia can be altered in the period immediately following allogeneic bone marrow transplantation (BMT). METHODS. By using a RIA, serum erythropoietin (sEpo) levels were serially measured in 10 BMT patients, from day -10 up to day +30, and the results correlated with the concurrent hemoglobin (Hb) value. Thirty healthy subjects and 15 iron-deficiency anemic patients were used in order to construct our own reference sEpo vs Hb curve. A sEpo value recorded in BMT patients was considered to be inappropriate for any given Hb value when falling below the lower 95% confidence limit of the control curve. RESULTS. Basal sEpo levels were significantly higher than in healthy subjects, and increased further during the BMT procedure, being still higher than controls on day +30. However, Epo production resulted inappropriate for each given Hb value, when compared with the control curve, in 60 out of 67 sEpo determinations performed following graft infusion. The inadequate Epo production was not associated with the development of clinically manifest signs of kidney toxicity. CONCLUSION. These data indicate that Epo production is impaired in the period immediately following BMT and suggest a role for the administration of recombinant human Epo in the short-term management of the anemia associated with BMT.