ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Translational Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1637441
Effect of Recombinant Human Erythropoietin on Postoperative Anemia in Children and Adolescents Undergoing Osteosarcoma and Potential Influencing Factors: A Single-center Retrospective Study
Provisionally accepted
- Department of pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Objective: This study assessed the efficacy of recombinant human erythropoietin (rhEPO) in treating postoperative anemia in children and adolescents with osteosarcoma and identified key factors influencing the therapeutic outcomes of this patient population. This retrospective study was conducted by pharmacists at a 4200-bed tertiary hospital in China using data from the Hospital Information System. It included patients aged 20 years or younger with osteosarcoma who underwent surgery after two cycles of neoadjuvant chemotherapy. Data were collected from January 1, 2014, to December 31, 2023. Patients were divided into two groups on the basis of whether they received rhEPO treatment perioperatively: a control group (n = 36) and a treatment group (n = 68). The outcome data from both groups were compared to evaluate the effectiveness of rhEPO treatment and to identify factors affecting outcomes in patients with postoperative anemia. Results: This study included 64 males and 40 females (1.6:1 ratio), with a median age of 13 years and 2 months. Baseline anemia was present in 92.31% of patients (mild: 56, moderate: 40). Multiple linear regression analysis revealed that the use of rhEPO was significantly positively associated with length of hospital stay (B = 3.459, SE = 0.200, P = 0.005). Specifically, this result indicates that patients who received EPO had a mean length of hospital stay that was 3.459 days longer than that of patients who did not receive EPO. Univariate linear regression demonstrated that preoperative medication use independently predicted reduced hemoglobin concentrations on postoperative day 3 (OR = 6.75, 95% CI: 2.314 to 19.692, P <0.001). Notably, Pearson correlation coefficients revealed a significant inverse relationship between total perioperative medication exposure and postoperative day 3 hemoglobin levels (r=-0.309, p=0.007). Binary logistic regression analysis further indicated that preoperative medication use was independent predictors of outcomes in patients with postoperative anemia following osteosarcoma surgery. Conclusion: rhEPO treatment can significantly shorten hospital stay for children and adolescents with postoperative anemia following osteosarcoma surgery. Preoperative rhEPO administration may help patients quickly recover from postoperative hemoglobin trough. Further prospective research is needed to validate these findings.
Keywords: Osteosarcoma, Recombinant human erythropoietin, Anemia, Hemoglobin, rhEPO, Perioperative Period
Received: 29 May 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Liu, Lin, Wenjun, Yao, Luo, Yu and Dai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lingyan Yu, lingyanyu@zju.edu.cn
Haibin Dai, haibindai@zju.edu.cn
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