A new concept for the differential diagnosis and therapy of anaemia in cancer patients
- 11 February 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in Supportive Care in Cancer
- Vol. 19 (2), 261-269
- https://doi.org/10.1007/s00520-010-0812-2
Abstract
This study aimed to prove the usefulness of the diagnostic plot, using the haemoglobin content of reticulocytes as a measure of functional iron deficiency (FID) and the ferritin index as a measure of iron availability, to customise anaemia treatment in cancer patients. Based on results of this plot, cancer patients fulfilling practice guideline criteria to receive erythropoiesis-stimulating agents (ESAs) were allocated to treatment with ESAs alone, iron alone or the combination of both. Primary endpoint was the percentage of patients identified to require iron in addition or as an alternative to ESA therapy. Out of 303 patients screened, 286 were allocated to treatment: 204 patients were normochromic and iron replete and treated with ESAs alone, 22 had both FID and anaemia of chronic disease and were treated with ESAs and parenteral iron, and 60 were iron-depleted and treated with iron only. After 8 weeks, a haemoglobin increase >1 g/dL from baseline was shown by 56% of patients treated with ESAs alone, by 100% of patients receiving the combination, by 50% of normochromic and by 73% of hypochromic iron-depleted patients receiving iron only. Acute phase reaction did not diminish the response rate to ESAs. The diagnostic plot was superior to transferrin saturation and ferritin in predicting iron availability in hypochromic patients treated with ESAs and proved useful to select treatment for anaemia in cancer patients.Keywords
This publication has 40 references indexed in Scilit:
- Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysisCMAJ : Canadian Medical Association Journal, 2009
- Iron supplementation and erythropoiesis‐stimulatory agents in the treatment of cancer anemiaCancer, 2009
- Characterization and Differentiation of Iron Status in Anemic Very Low Birth Weight Infants Using a Diagnostic NomogramNeonatology, 2008
- Parenteral iron with erythropoiesis-stimulating agents for chemotherapy-induced anemiaJournal of Oncology Pharmacy Practice, 2008
- Ferric Gluconate Is Highly Efficacious in Anemic Hemodialysis Patients with High Serum Ferritin and Low Transferrin SaturationJournal of the American Society of Nephrology, 2007
- EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer: 2006 updateEuropean Journal Of Cancer, 2007
- EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancerEuropean Journal Of Cancer, 2004
- Intravenous Iron Optimizes the Response to Recombinant Human Erythropoietin in Cancer Patients With Chemotherapy-Related Anemia: A Multicenter, Open-Label, Randomized TrialJournal of Clinical Oncology, 2004
- Erythropoietin resistance: the role of inflammation and pro‐inflammatory cytokinesNephrology Dialysis Transplantation, 2002
- Factors determining the percentage of hypochromic red blood cells in hemodialysis patientsKidney International, 1999