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Multicenter Study
. 2021 Feb 1;106(2):622-625.
doi: 10.3324/haematol.2020.250522.

Efficacy of recombinant erythropoietin in autoimmune hemolytic anemia: a multicenter international study

Bruno Fattizzo  1 , Marc Michel  2 , Anna Zaninoni  1 , Juri Giannotta  1 , Stephanie Guillet  3 , Henrik Frederiksen  4 , Josephine M I Vos  5 , Francesca R Mauro  6 , Bernd Jilma  7 , Andrea Patriarca  8 , Francesco Zaja  9 , Anita Hill  10 , Sigbiørn Berentsen  11 , Wilma Barcellini  1
Affiliations
Multicenter Study

Efficacy of recombinant erythropoietin in autoimmune hemolytic anemia: a multicenter international study

Bruno Fattizzo et al. Haematologica. .
No abstract available

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Figures

Figure 1.
Figure 1.
Relationship between endogenous erythropoietin and hemoglobin levels and response evaluation after recombinant erythropoietin treatment. (A) Continuous line shows the relationship in patients with autoimmune hemolytic anemia. Black circles represent patients responding to recombinant erythropoietin (rEPO) and white circles non responders; no significant differences were observed between these two groups. As controls, 49 aplastic anemia patients (white triangles) are shown, with the corresponding correlation (dotted- dashed line); dashed line represent patients with other types of anemia, including iron and vitamin deficiency [log(Epo)=4.478- (0.284xHb)] [Bergamaschi et al., Haematologica 2008 Dec;93(12):1785-91]. (B) Overall response rate to rEPO at different time points. Patients were treated for a median of 7 months and received mainly epoetin α 40,000 U/week (n=17, 33%) or darbepoetin α 20-300 mcg/week (n=20, 39%); a minority of cases received epoetin z 30,000 U/week (n=6, 12%) or β 30,000 U/week (N=1, 2%). Two patients received epoetin α 4,000 U/week because of co-existent chronic kidney disease. CR: complete response: PR: partial response; NR: no response).
Figure 2.
Figure 2.
Cytokine serum levels in patients with autoimmune hemolytic anemia and relationship with hematologic parameters and endogenous erythropoietin levels. Upper panel: serum cytokine individual values of autoimmune hemolytic anemia (AIHA) patients before therapy with recombinant erythropoietin (rEPO). Grey areas indicate mean+1 standard deviation of 40 age and sex matched healthy controls. TNF-α level was lower in AIHA than in controls (P<0.001), whereas IL10, IL6, IL17, and TGF-β levels were all higher (P<0.001, P<0.001, P=0.014, and P=0.002, respectively); IFN-γ level was comparable between patients and controls. Cytokines were evaluated using commercialeEnzyme-linked immunosorbent assay kits. Lower panel: correlation between endogenous EPO, bone marrow reticulocytes index (BMRI), hemoglobin (Hb) and cytokines. TNF-α positively correlated with endogenous EPO (r=0.77, P=0.005), and negatively with BMRI (r=-0.052, P=0.05). Moreover, IL6 and IL17 positively correlated with BMRI (r=0.45, not significant; r=0.53, P=0.04, respectively). Similar correlations were observed for reticulocytes (TNF-α: r=-0.051, P=0.05; IL6: r=0.53, P=0.04; IL17: r=0.61, P=0.02). Finally, a negative correlation was observed between TGF- β and Hb values (r=-0.63, P=0.04). Dashed line: negative correlation; continuous line: positive correlation.
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