Anemia is a common complication in patients with multiple myeloma (MM) occurring in more than two thirds of all patients. Anemia of chronic diseases, erythropoietin (EPO) deficiency due to renal impairment and the myelosuppressive effect of chemotherapy are the most important pathophysiological mechanisms contributing to the development of anemia in MM. In patients who achieve complete remission after chemotherapy, anemia usually normalizes. Non-responders and relapsing myeloma patients often continue to suffer from anemia. Treatment options for anemic myeloma patients include red blood cell transfusions and recombinant human EPO. This protein is biologically equivalent to the human endogenous hormone EPO, and its application leads to an increase in hemoglobin levels over an extended time without the risks presented by blood transfusions. Several studies reported a significant improvement of erythropoiesis, reduction in transfusion need, and improved quality of life by using EPO as long-term treatment of myeloma-associated anemia. In this article we propose the treatment of myeloma-associated anemia based on recommendations by the American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO); European Organisation for Research and Treatment of Cancer (EORTC); International Myeloma Foundation (IMF) and the National Comprehensive Cancer Network (NCCN).
Anemia; multiple myeloma; erythropoetin
