Tandem high-dose therapy (HDT) for multiple myeloma: recombinant human erythropoietin therapy given between first and second HDT allows second peripheral blood stem cell transplantation without red blood cell transfusion.

This is a very interesting and noteworthy study. We know that autologous transplants can cause severe anemia, but we also know that EPO therapy does not work well in the immediate post-transplant setting. This is probably because the bone marrow graft comes from the patient himself and is therefore usually pretreated with chemotherapy and less able to function rapidly. In this report of Baron et al, an appropriate amount of time was allowed for engraftment and recovery of transplant graft #1 before giving rHuEPO so that the rHuEPO could then stimulate enouogh RBC growth to raise Hb into the 12 g/dL range before transplant #2, thereby markedly decreasing the need for blood transfusion after transplant #2.

David H. Henry