The Use of Recombinant Human Erythropoietin (rHuEpo) after Reduced Intensity Conditioning (RIC) Allogeneic Hematopoietic Peripheral Blood Stem Cell Transplantation (ASCT) Reduce Red Blood Cell (RBC) Transfusion Requirements.

We previously reported that hemoglobin (Hb) recovery was hastened after RIC ASCT as compared with ASCT after myeloablative conditioning (Transfusion, 44:501–8, 2004). In this setting pretransplant Hb level becomes the major predictive factor for early Hb recovery posttransplant and RBC transfusion (RBCT) requirements. We subsequently reported the efficacy of early rHuEpo administration after RIC ASCT to hasten Hb reconstitution (BMT, 36:901–6, 2005). Here we further confirm the efficacy of early posttransplant administration of rHuEpo after RIC reducing RBC requirements and maintaining high levels of posttransplant Hb in the 2 months following transplant.Forty patients surviving at least 60 days were analyzed. Patients characteristics were as follow: age: 50 (27–64); M/F: 28/12; with myeloid (4), lymphoid (29) or solid (7) malignancies. They received a RIC (Fludarabin (150 mg/m²; Busulfan (8mg/kg) and thymoglobulin (2.5 to 5 mg/kg)) followed with an ASCT (all PBSC) from a HLA identical sibling. Aranesp® (Amgen, France) was started on day 1. The 20 first patients received an infusion of 150 mcg/week while the 20 last patients were subsequently treated with 500 mcg/3 weeks. Aranesp® was administered intravenously when inpatient and subcutaneously when outpatient. Aranesp® administration was sustained until day 60 or when patients reached a Hb level of 140 g/L, whichever occurred first. Overall patients were treated for a median of 7 weeks post transplant. No serious adverse effect or thrombosis episode related to Aranesp® was reported in these patients. This cohort of 40 patients experienced a quicker Hb recovery and lower RBCT requirements than a historical and comparable control group of 27 patients (Day +30 Hb: 114 (94–141) vs. 100 (80–129), p<.0001; patients with 0 or 1 RBCT: 83% vs. 55% (p=.02)). Thirteen of the 40 patients (33%) presented with an Hb level of 120 g/L or more prior to conditioning. Over the first 60 days, these patients received 0 (0–2) RBCT as compared with 1 (0–2) RBCT for patients with a pre-RIC Hb level < 120 g/L (p=.05). On this basis, we hypothesized the interest of increasing Hb level prior to RIC by adequate rHuEpo stimulation. With this perspective, we have treated 13 patients with Aranesp® (500 mcg, SC) 3 weeks prior RIC. Nine of these 13 pts (69%) reached an Hb level of 120 g/L or more on day −7 as compared to 35% in patients not receiving Aranesp ® prior to RIC (p=.04). This indicates that Aranesp® post RIC ASCT is efficient to hasten Hb recovery and decrease RBCTs. In addition, a comprehensive strategy to minimize RBCT in this setting might include pre-transplant stimulation. We will prospectively assess this hypothesis.