From the Guidelines
Multiple myeloma is known to cause a decrease in hemoglobin and red blood cell (RBC) counts, leading to anemia, which can be treated with recombinant human erythropoietin and darbepoetin alfa to maintain a target hemoglobin level around 12 g/dL. This condition occurs in approximately 70% of patients at diagnosis, resulting from the infiltration of cancerous plasma cells into the bone marrow, which disrupts normal blood cell production and crowds out healthy red blood cell precursors 1. The malignant cells also produce substances that suppress erythropoiesis, and the disease can cause kidney dysfunction, reducing erythropoietin production, a hormone essential for red blood cell production. Key factors contributing to anemia in multiple myeloma include:
- Bone marrow infiltration by cancerous plasma cells
- Suppression of erythropoiesis by substances produced by malignant cells
- Kidney dysfunction leading to reduced erythropoietin production
- Increased blood viscosity due to excessive protein production by myeloma cells, which can shorten red blood cell survival
- Potential for increased bleeding tendencies due to platelet dysfunction or coagulation abnormalities. Management of anemia is crucial in the supportive care of patients with multiple myeloma, aiming to alleviate symptoms such as fatigue, weakness, and shortness of breath, and treatment guidelines recommend maintaining a hemoglobin level below 14 g/dL to avoid thromboembolic complications and hypertension 1.
From the Research
Multiple Myeloma and Its Effects on Hemoglobin and RBC
- Multiple myeloma is a hematologic malignancy that can cause anemia, which is characterized by a decrease in hemoglobin and red blood cell (RBC) count 2.
- Anemia is a common complication in patients with multiple myeloma, occurring in more than two thirds of all patients 3.
- The underlying pathophysiological mechanisms of anemia in multiple myeloma include anemia of chronic disease, relative erythropoietin (EPO) deficiency, and myelosuppressive effects of chemotherapy 3, 4.
Causes of Decreased Hemoglobin and RBC in Multiple Myeloma
- Anemia of chronic disease is the most frequent underlying cause of anemia in multiple myeloma, characterized by impaired iron metabolism and inadequate EPO production 5, 4.
- Inadequate EPO production, even in patients without renal impairment, can contribute to defective erythropoietic activity and anemia 4.
- Other factors, such as hemodilution, bleeding, and decreased RBC survival, can also contribute to anemia in multiple myeloma 4.
Treatment and Management of Anemia in Multiple Myeloma
- Red blood cell transfusions can provide an immediate increase in hemoglobin levels, but their effects are transient and can be associated with risks such as infections and immunologic reactions 3.
- Recombinant human erythropoietin (rHuEPO) can increase hemoglobin levels over an extended period without the risks of blood transfusions and is recommended for anemic myeloma patients where other possible causes of anemia have been eliminated 3, 6.
- Erythropoiesis-stimulating agents (ESAs) have been used to manage anemia in multiple myeloma, but their use has been questioned due to potential risks such as thrombosis and detrimental impact on patient survival 5.