Intravenous iron alone resolves anemia in patients with functional iron deficiency and lymphoid malignancies undergoing chemotherapy.

Michael Hedenus,Marcel Felder,Bernard Roubert,Gunnar Birgegård,Heinz Ludwig,Torbjörn Karlsson,Beate Rzychon

doi:10.1007/s12032-014-0302-3

Abstract

This randomized trial evaluated ferric carboxymaltose without erythropoiesis-stimulating agents (ESA) for correction of anemia in cancer patients with functional iron deficiency. Patients on treatment for indolent lymphoid malignancies, who had anemia [hemoglobin (Hb) 8.5–10.5 g/dL] and functional iron deficiency [transferrin saturation (TSAT) ≤20 %, ferritin >30 ng/mL (women) or >40 ng/mL (men)], were randomized to ferric carboxymaltose (1,000 mg iron) or control. Primary end point was the mean change in Hb from baseline to weeks 4, 6 and 8 without transfusions or ESA. Difficulties with patient recruitment led to premature termination of the study. Seventeen patients (8 ferric carboxymaltose and 9 control) were included in the analysis. In the ferric carboxymaltose arm, mean Hb increase was significantly higher versus control at week 8 (p = 0.021). All ferric carboxymaltose-treated patients achieved an Hb increase >1 g/dL (control 6/9; p = 0.087), and mean TSAT was >20 % from week 2 onwards. No treatment-related adverse events were reported. In conclusion, ferric carboxymaltose without ESA effectively increased Hb and iron status in this small patient population.Electronic supplementary materialThe online version of this article (doi:10.1007/s12032-014-0302-3) contains supplementary material, which is available to authorized users.

Highlights

Anemia and iron deficiency are frequent complications in cancer patients, in those undergoing chemotherapy [1]
Inadequate iron supply is a major component in the pathogenesis of anemia in cancer patients [3].The estimated prevalence of insufficient iron availability in cancer patients ranges from 19–63 %, and functional iron deficiency (FID) is much more common than absolute iron deficiency [1, 3]
At least 30 % of anemic cancer patients do not respond to erythropoiesis-stimulating agents (ESA) treatment alone [6], and over recent years, the evidence has accumulated that red blood cell (RBC) transfusions, as well as ESA use outside the current label

Summary

Introduction

Anemia and iron deficiency are frequent complications in cancer patients, in those undergoing chemotherapy [1]. FID occurs when release of iron from internal stores is restricted (e.g., due to inflammation) or too slow to keep pace with erythropoiesis [e.g., after treatment with erythropoiesis-stimulating agents (ESA)]. It is characterized by low transferrin saturation (TSAT B 20 %) in spite of adequate iron stores, while serum ferritin levels usually are elevated [3, 4]. At least 30 % of anemic cancer patients do not respond to ESA treatment alone [6], and over recent years, the evidence has accumulated that RBC transfusions, as well as ESA use outside the current label

Methods

Results

Conclusion