Erythropoietin Treatment in Chronic Phase Chronic Myeloid Leukemia Patients Treated with Frontline Imatinib who Developed Late Anemia

BACKGROUND: Role of erythropoietin (EPO) in the treatment of late anemia in patients with Chronic Myeloid Leukemia (CML) is still undefined. METHODS: Fifty CML patients treated at 14 Institutions with frontline imatinib for at least 12 months and in stable complete cytogenetic response who developed a late chronic anemia treated with EPO were retrospectively evaluated. RESULTS: Median time from imatinib start to EPO treatment was 42.2 months [interquartile range (IQR) 20.8 - 91.9]. Median Hb value at EPO starting time was 9.9 g/dl (IQR 8.9 - 10.3): eleven patients (22.0%) were transfusion dependent. Alpha-EPO (40,000 UI weekly) was employed in 37 patients, beta-EPO (30,000 UI weekly) in 9 patients, zeta-EPO (40,000 UI weekly) in 2 patients and darbopoietin (150 mcg/weekly) in the remaining 2 patients. On the whole, 41 patients (82.0%) achieved an erythroid response, defined as a stable (> 3 months) improvement > 1.5 g/dl of Hb level, and 9 patients (18.0%) indeed resulted resistant. Among responding patients, 10 relapsed after a median time from EPO start of 20.7 months (IQR 10.8 - 63.7). No EPO-related toxicity was observed. CONCLUSIONS: Results of EPO treatment for late chronic anemia during long-lasting imatinib therapy are encouraging, with a high rate of response.