Mechanisms of anaemia in patients with malignancy: implications for the clinical use of recombinant human erythropoietin

Anaemia is a frequent finding in cancer and may be due to different causes. In untreated subjects, the most common type is the so-called anaemia of chronic disease, a condition characterised by excessive release of cytokines such as interleukin-1 and tumour necrosis factor. These peptides both inhibit erythroid marrow proliferation and blunt the normal exponential relationship between haematocrit and serum erythropoietin. Chemotherapy may cause or worsen anaemia in cancer patients. Cisplatin appears to be peculiar in that this drug can blunt erythropoietin production and cause prolonged anaemia. Controlled studies have demonstrated that recombinant human erythropoietin (rHuEPO) can ameliorate anaemia in patients with malignancy and prevent chemotherapy-induced anaemia. However, improvement of anaemia following rHuEPO treatment is seen in only a portion of cancer patients, and significant improvements of quality of life cannot be demonstrated in all responsive patients. Therefore, an important issue remains whom to treat.