Pathogenesis and modern therapy of anemia in elderly patients with lymphoproliferative diseases

Aim: To study the pathological mechanisms and modern methods of correction of anemia in elderly patients with lymphomas. Material and Methods: 102 patients with T-and B-cell lymphomas of over-65 age have been examined. Patients had different somatic pathology and anemia of varying severity. Iron metabolisms, serum erythropoietin, erythropoietin receptor on the surface of erythrokariocytes have been studied. The efficacy of the drug recombinant human erythropoietin for elderly patients with lymphomas has been investigated. Results: impaired iron metabolism at baseline was observed in 40.2 % of patients, thereat the serum ferritin levels were normal or elevated, indicating to the anemia resulting from disorders of iron metabolism. The average level of serum erythropoietin was 22.46 ± 24.3 IU/l. In 26.1 % of patients of EPO-R + cells was reduced. At the end of the treatment effect was positive in 78.3 % of patients, thus avoiding blood transfusions.

1. Anemia - the silent epidemic. Moscow: MegaPro, 2004. 76 p. (in Russian)

2. Bogdanova O.M. Clinical and hematological characteristic of hypochromic anemia in elderly and senile patients: abstract of thesis…candidate of medical sciences. Velikiy Novgorod, 2003. (in Russian)

3. Vartanian F., Mkrtchyan S. Demographic dynamics in the world // Vrach. 2001. (8). 43—44. (in Russian)

4. Dyachkova N.U., Kovynev I.B., Voropaeva E.N. and other. Secondary myelodysplasia effect on survival of patients with malignant lymphomas // Byulleten' Sibirskogo Otdeleniya Rossiyskoy Akademii Meditsinskikh Nauk. 2011. (2). 37– 40. (in Russian)

5. Targets for health for all. Proceedings of the WHO publication. Copenhagen, 2000. 238 p. (in Russian)

6. Kozinets G.I., Pogorelov V.M. Conservatism - stability of hematopoiesis // Klinicheskaya laboratornaya diagnostika. 1998. (12). 21—32. (in Russian)

7. Kondurtsev V.A., Pavlova T.V. Classification of the causes of anemia in elderly patients with myocardial infarction // Gematologiya i transfuziologiya. 2004. (4). 35—39. (in Russian)

8. Pavlov A.D., Morshchakova E.F. Etiology and pathogenesis of anemia of malignancy // Voprosy gematologii, onkologii i immunologii v pediatrii. 2004. 3. (1). 50—55. (in Russian)

9. Pogorelov V.M., Kozinets G.I., Kovaleva L.G. Laboratory and clinical diagnosis of anemia. Moskow: MIA, 2004. 173 p. (in Russian)

10. Pospelova T.I., Lyamkina A.S. Anemia in lymphomas. 2nd ed., rev. and add. Novosibirsk: Nauka, 2009. 150 p. (in Russian)

11. Romanenko N.A., Abdulkadyrov K.M. Pathogenetic correction of anemia in patients with lymphoproliferative diseases by erythropoiesis stimulation therapy (review) // Onkogematologiya. 2011. 93. (3). 39–50. (in Russian)

12. Romanenko N.A., Berkos M.V., Bessmeltsev S.S. et al. Prognostic value of serum erythropoietin in anemia preparations of recombinant erythropoietin in patients with lymphoproliferative disorders // Kazanskiy meditsinskiy zhurnal. 2012. 93. (4). 584–590. (in Russian)

13. Ania B.J., Suman V.J., Fairbanks V.F. et. al. Inci­dence of anemia in older people: an epide­mio­logic study in a well defined population // J. Am. Geriatr. Soc. 1997. 45. 825–831.

14. Argyniadon S., Vlachonikolis J., Melisopoulon H. et. al. What extent anemia coexists with cognitive impairment in elderly: a gross-sectional study in Greece // BMC Fam. Pract. 2001. 2. 5-10.

15. Barra S., Barzan L., Maione A. et al. Blood transfusion and other prognostic variables in the survival of patients with cancer of the head and neck // Laryngoscope. 1994. 104. 95–98.

16. Becker A., Stadler P., Lavey R.S. et al. Severe anemia is associated with poor tumor oxygenation in head and neck squamous cell carcinomas // Int. J. Radiat. Oncol. Biol. Phys. 2000. 46. 459–446.

17. Begnin Y. Erythropoiesis and erythropoietin in multiply myeloma // Leuk. Lymphoma. 1995. 18. 413–421.

18. Cabanillas M.E., Kantarjian H., Thomas D.A. et al. Epoetin alpha decreases the number of erythrocyte transfusions in patients with acute lymphoblastic leukemia, lymphoblastic lymphoma, and Burkitt leukemia/lymphoma: results of a randomized clinical trial // Cancer. 2012. 118. (3). 848–855.

19. Carmel R. Anemia and aging: an overview of clinical, diagnostic and biological issues // Blood Rev. 2001. 15. 9—18.

20. Cazzola M., Mercuriali F., Brugnara C. Use of recombinant human erythropoietin outside the setting of anemia // Blood. 1997. 89. 4248–4267.

21. Ludwig H., Fritz E., Kotzmann H. et al. Erythropoietin treatment of anemia associated with multiple myeloma // N. Engl. J. Med. 1990. 322. 1693–1699.

22. Means R.T., Krants S.B. Inhibition of human erythroid colony-forming units by tumor necrosis factor requires beta interferon // J. Clin. Invest. 1993. 91. 416–419.

23. Salvazini C., Casali B., Salvo D. et al. The role of interleukin-1, erythropoietin and red cell bound immunoglobulins in the anemia of rheumatoid arthritis // Clin. Exp. Rheumatol. 1991. 9. 241–246.

24. Schooley J.C., Kulgren B., Allison A.C. Inhibition by interleukin-1 of the action of erythropoietin on erythroid precursors and its possible role in the pathogenesis of hypoplastic anaemias // Br. J. Hematol. 1987. 67. 11–17.

25. Suzuki Y., Tokuda Y., Fujiwara Y. et al. Weekly epoetin beta maintains haemoglobin levels and improves quality of life in patients with non-myeloid malignancies receiving chemotherapy // Jpn. J. Clin. Oncol. 2008. 38. (3). 214–221.

26. Truong P.T., Parhar T., Hart J. et al. Population-based analysis of the frequency of anemia and its management before and during chemotherapy in patients with malignant lymphoma // Am J. Clin. Oncol. 2010. 33. (5). 465–468.

27. Tsuboi M., Ezaki K., Tobinai K. et al. Weekly administration of epoetin beta for chemotherapy-induced anemia in cancer patients: results of a multicenter, Phase III, randomized, double-blind, placebo-controlled study // Jpn. J. Clin. Oncol. 2009. 39. (3). 163–168.

28. Yang S., Jun M., Hong-Li Z. et al. A multi-center open-labeled study of recombinant erythropoietin-beta in the treatment of anemic patients with multiple myeloma, low-grade non-Hodgkin’s lymphoma, or chronic lymphocytic leukemia in Chinese population // Int. J. Hematol. 2008. 88. (2). 139–144.

29. Zijlstra J., Sturm I., Topp M.S. et al. Epoetin alfa in patients with advanced-stage Hodgkin’s lymphoma: results of the randomized placebo-controlled GHSG HD15EPO trial // J. Clin. Oncol. 2010. 28. (13). 2239–2245.

30. Zucker S. Anemia in cancer // Cancer Invest. 1985. 3. 249–260.

Vorotnikov I.B. – candidate of medical sciences, physician, e-mail: post_gem@mail.ru