Treatment of Anemia Associated with Multiple Myeloma

To the Editor: The endorsement by Bergsagel et al. (Jan. 3 issue) 1 of inexpensive oral androgen as opposed to expensive erythropoietin as a hematostimulant in multiple myeloma is unfortunate, primarily because the oral route fails to avoid the first-pass effect through the liver. Oral testosterone (methylated) frequently produces derangements of liver enzyme levels and liver disease, as pointed out by Ludwig et al. 2 in their discussion of the potential dangers of this therapy. Since 1961, when Gardner and Pringle 3 introduced parenteral androgens for aplastic anemia (and disposable syringes became available), intramuscular testosterone has been employed in thousands receiving cancer chemotherapy . . .