Anemia in diffuse large B-cell non-Hodgkin lymphoma: the role of interleukin-6, hepcidin and erythropoietin.

Maria Chiara Tisi, Valentina Bozzoli, Manuela Giachelia, Giuseppina Massini, Bianca Maria Ricerca Storti, Elena Maiolo, Francesco D'Alo', Luigi Maria Larocca, Alfonso Piciocchi, Harold Tjalsma, Dorine W. Swinkels, Maria Teresa Voso, Giuseppe Leone, Stefan Hohaus

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34 Citations (Scopus)


Anemia is a frequent sign in patients with diffuse large B-cell lymphoma (DLBCL) at diagnosis. We determined erythropoietin, hepcidin and interleukin-6 (IL-6) in plasma samples of 53 patients with DLBCL. The majority of patients (40/53, 75%) showed defective endogenous erythropoietin production, in particular when anemia was present (p = 0.01). Hepcidin plasma levels were significantly higher in patients compared to controls (p = 0.006), particularly in those with characteristics associated with a more active disease, including elevated lactate dehydrogenase (LDH) (p = 0.0004), B-symptoms (p = 0.07) and an age-adjusted international prognostic index (IPI) score > 1 (p = 0.01). Hepcidin levels correlated strongly to ferritin (r = 0.77, p < 0.0001) and weakly to IL-6 concentrations (r = 0.30, p = 0.03), but not to hemoglobin values. IL-6 inversely correlated to hemoglobin values in both univariate and multivariate analysis (p = 0.04), including hepcidin and erythropoietin as variables. Our findings suggest that elevated hepcidin levels and inadequate erythropoietin response are frequent in DLBCL, but elevated IL-6 plays the major role for the development of anemia.
Original languageEnglish
Pages (from-to)270-275
Number of pages6
Publication statusPublished - 2014


  • Lymphoma
  • anemia


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