Cancer-related anaemia requires higher doses of epoetin alfa than chronic renal failure replacement therapy.

Epoetin alfa has been used effectively for over a decade as hormone replacement therapy in the treatment of anaemia in patients with chronic renal failure (chronic kidney disease). In this condition, erythropoietin production is impaired and the resulting deficiency is the primary cause of the normocytic, normochromic anaemia typically observed w1x. The recommended initial epoetin alfa dosages in this patient population are 50–100 Uukg three times weekly (TIW) intravenously (i.v.) or subcutaneously (s.c.) in adults and 50 Uukg TIW i.v. or s.c. in children. Because of the extensive experience with epoetin alfa in the nephrology community, oncologists may seek advice in the use of the drug to treat cancer-related anaemia. It is important to note that the pathogenesis of cancerrelated anaemia differs from that of the anaemia of chronic renal failure. While the aetiology of anaemia in patients with cancer can be multifactorial, it closely resembles the anaemia of chronic disease w2,3x, with inappropriately low erythropoietin levels for the degree of anaemia compared with iron deficiency anaemia w4,5x. Anaemia of chronic disease is also characterized by excessive release of inflammatory cytokines such Correspondence and offprint requests to: Loretta M. Itri, MD, Genta, Inc., 2 Oak Way, Berkeley Heights, NJ 07922, USA. E-mail: [email protected] 2289 Nephrol Dial Transplant (2001) 16: Editorial Comments