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Park LC, Song YJ, Kim DJ, Kim MJ, Jo JC, Lee WS, Shin HJ, Oh SY, Do YR, Jeong JY, Lee HS. The effects of erythropoiesis-stimulating agents on the management of chemotherapy-induced anemia and tumor growth in diffuse large B-cell lymphoma patients. Int J Cancer 2019; 145:2459-2467. [PMID: 30973963 DOI: 10.1002/ijc.32328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 11/11/2022]
Abstract
Erythropoiesis-stimulating agents (ESAs), such as erythropoietin (EPO) and darbepoetin, may alleviate anemia in diffuse large B-cell lymphoma (DLBCL) patients. However, many cancer cells express EPO receptors (EPOR), through which exogenously administered ESAs potentially promote cancer cell growth. We conducted preclinical/phase II studies to investigate the safety and efficacy of ESAs for managing chemotherapy-related anemia in DLBCL patients. We examined EPOR expression in germinal center B-cell (GCB)- and activated B-cell (ABC)-DLBCL cell lines, and investigated the effects of ESAs on cell proliferation, and rituximab-mediated complement-dependent cytotoxicity (CDC). The clinical study enrolled 50 histologically confirmed DLBCL patients receiving rituximab/cyclophosphamide/doxorubicin/vincristine/prednisolone (R-CHOP) who had hemoglobin levels <10.0 g/dl after a maximum of three R-CHOP cycles and received ≥4 doses of fixed-dose darbepoetin (360 μg) once every 3 weeks. EPOR mRNA was detected in all GCB-DLBCL cell lines, but little/none was detected in ABC-DLBCL cell lines. GCB-DLBCL and ABC-DLBCL cell proliferation was unaffected by EPO or darbepoetin. Rituximab-mediated CDC of DLBCL cell lines with/without EPOR expression was not affected adversely by EPO. In the clinical study, baseline mean hemoglobin was 9.19 g/dl; the overall mean change in hemoglobin was 1.59 ± 1.3 g/dl (16 weeks). Forty-eight percent of enrolled patients achieved a hematopoietic response. Our study shows that ESAs do not affect the growth of DLBCL cells or rituximab-mediated CDC under the experimental conditions that we used, and the appropriate use of ESAs may be effective and safe for DLBCL patients with anemia after R-CHOP.
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Affiliation(s)
- Lee Chun Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Yeon-Joo Song
- Central Medical Research Institute, Kosin University Gospel Hospital, Busan, South Korea.,Cancer Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Da Jung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Min-Jung Kim
- Cancer Research Institute, Kosin University College of Medicine, Busan, South Korea.,Department of Biochemistry, Kosin University College of Medicine, Busan, South Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Won Sik Lee
- Department of Internal Medicine, Busan Paik Hospital, Busan, South Korea
| | - Ho-Jin Shin
- Department of Internal Medicine, Busan National University Hospital, Busan, South Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Young Rok Do
- Department of Hemato-Oncology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jee-Yeong Jeong
- Cancer Research Institute, Kosin University College of Medicine, Busan, South Korea.,Department of Biochemistry, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
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2
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Gagnon B, Mancini I, Pereira J, Bruera E. Palliative Management of Bleeding Events in Advanced Cancer Patients. J Palliat Care 2019. [DOI: 10.1177/082585979801400409] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bruno Gagnon
- Palliative Care Program, Regional Palliative Care Program, Grey Nuns Community Hospital and Health Centre, Edmonton, Alberta, Canada
| | - Isabelle Mancini
- Palliative Care Program, Regional Palliative Care Program, Grey Nuns Community Hospital and Health Centre, Edmonton, Alberta, Canada
| | - Jose Pereira
- Palliative Care Program, Regional Palliative Care Program, Grey Nuns Community Hospital and Health Centre, Edmonton, Alberta, Canada
| | - Eduardo Bruera
- Palliative Care Program, Regional Palliative Care Program, Grey Nuns Community Hospital and Health Centre, Edmonton, Alberta, Canada
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3
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Yang S, Jun M, Hong-Li Z, Jian-Min W, Chun W, Lu-Gui Q, Yong-Qiang Z, Jun Z, Jian H, Zhi-Xiang S. A multi-center open-labeled study of recombinant erythropoietin-beta in the treatment of anemic patients with multiple myeloma, low-grade non-Hodgkin's lymphoma, or chronic lymphocytic leukemia in Chinese population. Int J Hematol 2008; 88:139-144. [PMID: 18629603 DOI: 10.1007/s12185-008-0130-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 05/30/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this study is to investigate the efficacy and safety of recombinant erythropoietin-beta in the treatment of anemic patients with multiple myeloma (MM), low-grade non-Hodgkin's lymphoma (NHL), and chronic lymphocytic leukemia (CLL). From December 2005 to November 2006, the patients with MM, low-grade NHL, and CLL were enrolled in this study, male or female, aged > or = 18 years, transfusion-dependant, and receiving anti-neoplasia chemotherapy. Recombinant human erythropoietin-beta was used in this study with the dose initiated at 150 IU/kg, thrice a week, subcutaneously. The total treatment duration was 12 weeks. The primary endpoint of the study is response rate (RR), which is defined as hemoglobin increasing > or = 2 g/dL comparing to baseline level, or returning to normal range, without any transfusion within 6 weeks of evaluation. Fifty out of 82 (64.6%) patients enrolled in this study responded to the treatment and 29 patients had no response. Hypertension (12.2%) is the most common adverse effect; however, all the adverse events were mild, categorized in NCI grade I or II. We conclude that recombinant erythropoietin-beta was effective in the treatment of anemia of the patients with MM, NHL, and CLL, as well as it is well-tolerated.
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Affiliation(s)
- Shen Yang
- Department of Hematology, Ruijin Hospital, Shanghai JiaoTong University, School of Medicine, No.197 Ruijin Road II, Shanghai, 200025, China.
| | - Ma Jun
- Department of Hematology, Harbin Institute of Hematology, Harbin, China
| | - Zhu Hong-Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Wang Jian-Min
- Department of Hematology, Changhai Hospital, Shanghai Second Military Medical University, Shanghai, China
| | - Wang Chun
- Department of Hematology, Shanghai First People's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Qiu Lu-Gui
- Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhao Yong-Qiang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Zhu Jun
- Beijing Cancer Hospital, Beijing, China
| | - Hou Jian
- Department of Hematology Changzheng Hospital, Shanghai Second Military Medical University, Shanghai, China
| | - Shen Zhi-Xiang
- Department of Hematology, Ruijin Hospital, Shanghai JiaoTong University, School of Medicine, No.197 Ruijin Road II, Shanghai, 200025, China
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Abstract
Intensification of therapeutic regimens, improved patient survival, and advances in cytokine and cellular therapies have led to increasingly complex requirements for transfusion and stem cell support in cancer treatment. This article focuses on current and evolving issues in red blood cell, platelet, and granulocyte transfusion support, as well as measures to avoid increasingly important complications of transfusion therapy, such as alloimmunization, graft-versus-host disease, cytomegalovirus infection, and immunomodulation. Issues concerning current applications of hematopoietic stem cell transplantation and future prospects also are discussed.
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Affiliation(s)
- D L Wuest
- Hematology Service, Memorial Sloan-Kettering Cancer Center, New York, USA
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