恶性肿瘤贫血中对重组人促红细胞生成素（rHuEpo）反应的预测

Prediction of response to recombinant human erythropoietin (rHuEpo) in anemia of malignancy.

作者信息

Cazzola M, Ponchio L, Pedrotti C, Farina G, Cerani P, Lucotti C, Novella A, Rovati A, Bergamaschi G, Beguin Y

机构信息

Department of Internal Medicine and Medical Therapy, University of Pavia Medical School, IRCCS Policlinico S. Matteo, Italy.

出版信息

Haematologica. 1996 Sep-Oct;81(5):434-41.

PMID:8952157

Abstract

BACKGROUND

Since only a portion of anemic patients outside the uremia setting benefit from erythropoietin treatment, a reliable means of predicting potential responders and nonresponders would be very useful.

MATERIALS AND METHODS

We retrospectively reviewed the clinical records of 58 patients with refractory anemia associated with various malignant disorders who had been treated with subcutaneous rHuEpo. The starting rHuEpo dose was 375 U/kg/week for 4 weeks, and was increased to 750 U/kg/week for another 4 weeks if no response was observed. Response was defined as a Hb increase > or = 2 g/dL with no need for blood transfusion. We examined the value of various laboratory parameters (baseline levels, 2-week and 4-week changes) as predictors of response. Endogenous erythropoietin production was evaluated by its serum level and erythroid activity was assessed through reticulocyte count and circulating transferrin receptor.

RESULTS

Forty-eight individuals were evaluable, 58% of whom responded to rHuEpo within 8 weeks. Multiple regression analysis showed that 53% of the variation in the 8-week Hb concentration was explained by variations in baseline serum erythropoietin and the 2-week change in serum transferrin receptor (p < 0.001). Based on these two parameters, response prediction in individual patients would have resulted in a sensitivity of 96%, a specificity of 79% and an overall accuracy of 88%. In addition, 58% of the variation in the 8-week Hb was explained by variations in the 4-week changes in Hb and reticulocyte count (p < 0.001). Utilizing these latter parameters and baseline serum erythropoietin, response prediction in individual patients would have resulted in a sensitivity of 92%, a specificity of 82% and an overall accuracy of 88%.

CONCLUSIONS

This retrospective analysis suggests that response to rHuEpo can be reasonably predicted by pretreatment serum erythropoietin together with early changes in simple laboratory parameters.

摘要

背景

由于仅一部分非尿毒症性贫血患者能从促红细胞生成素治疗中获益，因此，一种可靠的预测潜在反应者和无反应者的方法将非常有用。

材料与方法

我们回顾性分析了58例接受皮下注射重组人促红细胞生成素（rHuEpo）治疗的、与各种恶性疾病相关的难治性贫血患者的临床记录。起始rHuEpo剂量为375 U/kg/周，持续4周，若未观察到反应，则在接下来的4周内将剂量增加至750 U/kg/周。反应定义为血红蛋白（Hb）升高≥2 g/dL且无需输血。我们检查了各种实验室参数（基线水平、2周和4周变化）作为反应预测指标的价值。通过血清水平评估内源性促红细胞生成素的产生，并通过网织红细胞计数和循环转铁蛋白受体评估红系活性。

结果

48例患者可评估，其中58%在8周内对rHuEpo有反应。多元回归分析显示，8周时Hb浓度变化的53%可由基线血清促红细胞生成素和血清转铁蛋白受体2周变化的差异解释（p<0.001）。基于这两个参数，对个体患者的反应预测将导致敏感性为96%，特异性为79%，总体准确率为88%。此外，8周时Hb变化的58%可由Hb和网织红细胞计数4周变化的差异解释（p<0.001）。利用这些后一组参数和基线血清促红细胞生成素，对个体患者的反应预测将导致敏感性为92%，特异性为82%，总体准确率为88%。