Use of recombinant human erythropoietin after bone marrow transplantation in pediatric patients with acute leukemia: Effect on erythroid repopulation in autologous versus allogeneic transplants

We carried out a pilot study on the use of recombinant human erythropoietin (rHuEPO) in children undergoing allogeneic or mafosfamide-purged autologous BMT for ALL or AML. rHuEPO was administered intravenously at a dose of 75 U/kg/day for 30 days after transplant. Ten rHuEPO-treated patients receiving allogeneic BMT and 10 given autologous BMT were compared with 15 allogeneic and 10 autologous historical controls. Endogenous EPO production was appropriate for the degree of anemia after autologous BMT. In these patients, rHuEPO did not accelerate erythroid repopulation and did not modify transfusion requirements. With allogeneic BMT, erythroid marrow activity increased faster in patients given rHuEPO than in controls and resulted in higher red cell production, the mean reticulocyte count on day +30 being 187 ± 51 x 109/l in treated patients versus 107 ± 63 x 109/l in controls (p < 0.01). The total number of RBC units administered was 1.7 ± 1.3 in the rHuEPO group versus 5.1 ± 3.0 in the control group (p < 0.001). The total number of platelet transfusions was 4.0 ± 2.3 for patients given allogeneic BMT and receiving rHuEPO versus 8.4 ± 6.8 for historical controls (p < 0.05) whereas it was similar in rHuEPO-treated and control autologous BMT patients. We conclude that (1) rHuEPO accelerates erythroid recovery and may reduce red cell and platelet transfusion requirements in children with acute leukemia given allogeneic BMT, (2) after mafosfamide-purged autologous BMT the development of erythropoiesis is mainly determined by the marrow proliferative capacity, and (3) due to the scarcity of committed progenitors, recipients of purged autologous BMT are unlikely to benefit from early administration of rHuEPO.