Ludwig H, Fritz E, Leitgeb C, Pecherstorfer M, Samonigg H, Schuster J
First Department of Medicine and Medical Oncology, Wilhelminenspital, Vienna, Austria.
Blood. 1994 Aug 15;84(4):1056-63.
Chronic anemia of cancer can be corrected in approximately 50% of the cases by treatment with recombinant human erythropoietin (rHuEPO). Early prediction of responsiveness would avoid the emotional and financial burden of ineffective medical intervention. Eighty patients with chronic anemia of cancer undergoing treatment with rHuEPO (150 U/kg, 3 times per week by subcutaneous injection; after 6 weeks without response, 300 U/kg) participated in this study. Response was defined as a gain of at least 2 g/dL hemoglobin (Hb) within 12 weeks. Multivariate discriminant analysis and logistic regression analysis of response were performed on routine blood tests; serum levels of EPO, iron, ferritin, transferrin, and its receptor; World Health Organization (WHO) performance status; various cytokines; neopterin; stem cell factor; C-reactive protein; and alpha 1-antitrypsin. At baseline, none of these factors showed sufficient prognostic power. The following predictive algorithm was developed: (1) If after 2 weeks of therapy both the serum EPO level is > or = 100 mU/mL and Hb concentration has not increased by at least 0.5 g/dL, unresponsiveness of the patient is very likely (predictive power, 93%); otherwise, response may be predicted with an accuracy of 80%. (2) If both the serum level of EPO is less than 100 mU/mL and Hb concentration has increased by > or = 0.5 g/dL, response is highly probable (predictive power, 95%). (3) Alternatively, a serum ferritin level of > or = 400 ng/mL after 2 weeks of rHuEPO therapy strongly indicates unresponsiveness (predictive power, 88%), whereas a level less than 400 ng/mL suggests response in 3 of 4 patients.
约50%的癌症慢性贫血患者通过重组人促红细胞生成素（rHuEPO）治疗可得到纠正。对治疗反应性进行早期预测可避免无效医疗干预带来的情感和经济负担。80例接受rHuEPO治疗（150 U/kg，每周皮下注射3次；6周无反应后，剂量增至300 U/kg）的癌症慢性贫血患者参与了本研究。反应定义为12周内血红蛋白（Hb）至少增加2 g/dL。对常规血液检查、血清促红细胞生成素、铁、铁蛋白、转铁蛋白及其受体水平、世界卫生组织（WHO）体能状态、多种细胞因子、新蝶呤、干细胞因子、C反应蛋白和α1-抗胰蛋白酶进行反应的多变量判别分析和逻辑回归分析。在基线时，这些因素均未显示出足够的预后能力。开发了以下预测算法：（1）治疗2周后，如果血清促红细胞生成素水平≥100 mU/mL且Hb浓度未至少增加0.5 g/dL，则患者很可能无反应（预测能力，93%）；否则，反应预测准确率为80%。（2）如果血清促红细胞生成素水平低于100 mU/mL且Hb浓度增加≥0.5 g/dL，则很可能有反应（预测能力，95%）。（3）另外，rHuEPO治疗2周后血清铁蛋白水平≥400 ng/mL强烈提示无反应（预测能力，88%），而低于400 ng/mL则提示4例患者中有3例有反应。
