Anemia in Multiple Myeloma and Its Management.

Anemia is a frequent finding in patients with myeloma, second only to skeletal lytic lesions. Approximately 70% of patients have anemia at diagnosis a median hemoglobin of approximately 10.5 g/dL. The severity of anemia is important in determining the stage and prognosis of disease as determined by the Durie and Salmon staging criteria. Like anemia of chronic disease, the anemia of myeloma is generally normochromic and normocytic, and it is characterized by shortened erythrocyte survival with failure of the bone marrow to compensate by increased red cell production. This depressed red cell production is multifactorial and includes the following factors: (1) impaired availability of storage iron, (2) inadequate erythropoietin response to the level of anemia, and (3) overproduction of cytokines that are capable of inhibiting erythropoiesis.2 In addition to direct inhibitory effects on erythroid precursors, these cytokines (including tumor necrosis factor, interleukin-1, and interleukin6) may decrease reutilization of iron stores from reticuloendothelial cells and may interfere with erythropoietin production by the kidney.