Maximum responses appeared to occur by eight weeks of therapy, and there was no substantial difference between the 1,000 and 10,000 U daily doses. These investigators concluded that the decision to use rHuEpo in a patient with anemia associated with myeloma should be based on pretreatment serum levels. Essentially all studies have shown that rHuEpo is effective and safe in patients with anemia associated with myeloma. Patients who respond have improved quality of life and are not exposed to the risks associated with repeated blood transfusions. The drug appears safe, and hypertension or hyperviscosity syndromes have not been a significant problem.
Questions remain, however, regarding which patients to treat.
Issues regarding when to stop the drug because of lack of response vs increasing the dose also are unresolved. Waiting until the patient becomes overtly symptomatic from anemia is not advised. Patients who are symptomatic from anemia may need blood transfusions before beginning rHuEpo. In this subset of patients, anemia represents the only symptomatic problem, and correction of the problem with rHuEpo may delay the need for chemotherapy until the disease progresses. In contrast to this situation, patients with more advanced disease may have improvement in their anemia when treated with chemotherapy.