Hemopoiesis and Aging

ConclusionsAging appears associated with a progressive reduction in hemopoietic reserve due to exhaustion of pluripotent stem cells, increased circulation of catabolic cytokines, and possibly alterations in the microenvironment and in the production of hemopoietic growth factors. In many respects hemopoiesis may reflect general age-related changes.Whereas hemopoiesis is adequate to maintain the homeostasis of the peripheral blood, it may fail in presence of hemopoietic stress. This event is documented by increased incidence and prevalence of anemia with aging and increased risk of mielodepression following cytotoxic chemotherapy.In older individuals anemia is associated with increased risk of death, cardiovascular diseases, pharmacologic complications, dementia and functional dependence.Filgrastim, pegfilgrastim, erythropoietin ± and darbepoietin ± are effective in older individuals, may prevent complications of cytotoxic chemotherapy, such as neutropenic infections and fatigue, and may lead to cost savings.The current ASCO guidelines recommend that prophylactic filgrastim or pegfilgrastim be used in patients aged 65 and older who receive moderately toxic chemotherapy and that the hemoglobin of these patients be maintained at 12 gm/dl or higher.