COMMENTARY Management of disease-related anemia in patients with multiple myeloma or chronic lymphocytic leukemia: epoetin treatment recommendations Heinz Ludwig* ,1 , Kanti Rai 2 , Joan Blade 3 , Franco Dammacco 4 , Laurent Degos 5 , Loretta Itri 6 , Robert Kyle 7 , Vicenzo Liso 8 , Timothy James Littlewood 9 , Franco Mandelli 10 , Giovanna Meloni 11 , Stefano Molica 12 , Anders Osterborg 13 , Gerassimos A Pangalis 14 , Jesus San Miguel 15 , Barbara Schmitt 16 and Dimitrios Voliotis 17 1 Department of Medicine and Medical Oncology, Wihelminenspital, Montleartstrasse 37, A-1171 Vienna, Austria; 2 Long Island Jewish Medical Center, Division of Hematology/Oncology, 270-05 76th Avenue, New Hyde Park, New York, NY 11040, USA; 3 Hematology Department, Barcelona University Hospital Clinic, Villarroel, Barcelona, 170-08036, Spain; 4 Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Medical School, Piazza Giulio Cesare, Bari 70124, Italy; 5 Department of Haematology, Hospital Saint-Louis, 1 Avenue Claude Vellefaux, 10ieme arrondisement, Paris 75010, France; 6 Genta, Inc., 2 Connel Drive, Berkeley Heights, New Jersey, NJ 07922, USA; 7 Mayo Clinic, 200 First Street SW, Rochester, Minnesota, MN 55905, USA; 8 Department of Hematology, University of Bari Medical School, Bari 70124, Italy; 9 Department of Haematology, John Radclie Hospital, Headington, Oxford OX3 NDU, UK; 10 Department of Human Biopathology, Haematology Section, University La Sapienza, Via Benevento, 6, Rome 00161, Italy; 11 Department of Cellular Biotechnology and Hematology, University La Sapienza, Via Benevento, 6, Rome 00161, Italy; 12 Department Hematology/Oncology, Azienda Ospedaliera Pugliese- Ciaccio, Division of Haematology and Clinical Oncology, Catanzaro 88100, Italy; 13 Department of Oncology, Karolinska Hospital and Institute, King Gustaf Vth Jubilee Clinica and the Radiumhemmet, S-171 76 Stockholm, Sweden; 14 First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; 15 Department of Hematology, University of Salamanca, Hospital Universitario de Salamanca, Spain; 16 Grosshadern Clinic, Medical Clinic III, Marchioninstr. 15, Munich D-81377, Germany; 17 Clinic I for Internal Medicine, Department of Hematology and Oncology, University of Cologne, 50924 Cologne, Germany Multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) patients often develop anemia due to the disease process and eects from disease therapy. Blood transfusion, the established treatment, has an immediate eect in improving patients' hemoglobin levels. However, this eect is transient and transfusion is associated with several risks, including infections and mild to life-threatening immunologic reactions. A newer option is recombinant human erythropoietin (epoetin); a biological treatment that leads to increased hemoglobin levels over an extended time without the risks of blood transfusion. Extensive evidence has shown that epoetin is eective in the treatment of cancer-associated anemia. An international expert panel met to develop treatment recommendations for the use of epoetin in MM and CLL patients. Based on the available data, it is recommended that treatment be initiated only after other possible causes of anemia are eliminated. Epoetin should be administered to any patient with hemoglobin 410 g/dl. Patients with hemoglobin 10 ± 12 g/dl should receive epoetin if they suer from signi®cant symptoms of anemia and/or have progressively decreasing hemoglobin values. Dosage should be initiated at 10 000 IU three times/week or 40 000 IU once/week and be titrated to maintain hemoglobin at 12 g/dl. Nonresponsive patients (51 g/dl increase over four weeks) may have their dose increased to 20 000 IU three times/week or 60 000 IU once/week, respectively. Epoetin treatment should be discontinued if there is no response to the increased dosage, or hemoglobin 414 g/dl. Treatment should resume for patients who exceed 14 g/dl, at a reduced dosage, if their hemoglobin falls below 12 g/dl. The Hematology Journal (2002) 3, 121 ± 130. doi:10.1038/sj.thj.6200160 Keywords: multiple myeloma; chronic lymphocytic leukemia; recombinant human erythropoietin; epoetin; anemia *Correspondence: Heinz Ludwig, Department of Medicine and Medical Oncology, Wihelminenspital, Montleartstrasse 37, A-1171 Vienna, Austria Tel: +43 1 49150 2101; Fax: +43 1 49150 2109; E-mail: Heinz.Ludwig@1me.wil.magwien.gv.at Received 26 June 2001; accepted 11 January 2002 The Hematology Journal (2002) 3, 121 ± 130 ã 2002 The European Haematology Association All rights reserved 1466 ± 4680/02 $25.00 www.nature.com/thj