letter to the editor Haematologica 1996; 81:381-382

Barosi et al.1 recently reported guidelines for the clinical use of erythropoietin (rHuEPO); they emphasized that rHuEPO is rarely indicat-ed in myelodysplastic (MDS) patients. However, many recent experienced have suggested it may have a beneficial effect when given alone in some MDS patient.2- 6 The high doses of rHuEPO used in these studies (approximatively 100 times higher than normal serum levels) could conceivably stimulate either the abnormal MDS clone or the remaining normal erythro-poietic precursor cells, thereby accounting for the observed responses. We report a good durable response to high doses of rHuEPO in a young patient with a long disease history. A 28-year-old woman with a thalassemic trait (HbA2 4.19%, HbF 4.57%) was referred to our institu-tion in January 1981 because of anemia (Hb 7.6 g/dL); all other hematological parameters were in the normal range, and bone marrow aspirate showed an increase of erythroblastic cells with significant dysplastic features in the erythroid as well as megakaryocytic series without blasts (RA according to FAB classification). A 3-month period of oral vitamin B6 was given without clinical improvement. In October 1981 spleen enlargement (5 cm below costal margin) was observed, with a decrease in Hb levels (Hb < 6.5 g/dL) and the appearance of thrombocytopenia (Plts < 603109/L); ferrokinetic studies revealed anemia with qualitative and quantitative ery-thropoietic defects and a reduced red cell life span. Platelet survival was shortened by the presence of hypersplenism. On the basis of these findings a splenectomy was performed in February 1982 and the platelet count subse-quently normalized; however, Hb levels and transfusional requirements did not improve. Histological examination of the spleen did not reveal the presence of myeloid metaplasia. To maintain Hb concentration at 8-9 g/dL the patient needed about 3-4 units of packed red cells/month. In October 1991 we started rHuEPO treatment (400 U/kg twice a week sc). Hematological parameters before treatmen