Physiologic basis for the pharmacologic use of recombinant human erythropoietin in surgery and cancer treatment

Background. Recombinant human erythropoietin (rHuEPO) is approved for the treatment of the anemia of chronic kidney failure and anemia associated with zidovudine therapy of acquired immunodeficiency syndrome. In chronic kidney failure and other conditions such as cancer and hematologic malignancies, the endogenous erythropoietin response to anemia is blunted and rHuEPO might be beneficial in these conditions. Methods. We reviewed preclinical and clinical trial results with rHuEPO in a variety of conditions. Results. It is clear that chronic anemias of several causes respond to pharmacologic doses of rHuEPO. rHuEPO has been shown to enhance erythropoiesis before elective surgery, reduce the number of patients exposed to homologous blood at the time of coronary artery bypass grafting, reverse the anemia in most patients with cancer, and result in clinical benefit in 25% to 35% of patients with myelodysplasia. Conclusions. rHuEPO is important as a therapeutic means to correct anemia. rHuEPO is likely to be useful in correcting chronic anemias or anemias associated with chemotherapy, particularly in those patients with expected long-term survival. Issues to be resolved include the accurate prediction and targeting of rHuEPO therapy for patients most likely to respond.