Abstract
BackgroundAnemia is a major cause of morbidity in patients with cancer resulting in poor physical performance, prognosis and therapy outcome. The aim of this study is to assess the efficacy of intravenous (iv) iron administration for the correction of anemia, for the prevention of exacerbation of anemia, for decreasing blood transfusion rates, and for the survival of cancer patients.MethodsPatients with different solid tumor diagnosis who received iv iron during their cancer treatment were evaluated retrospectively. Sixty-three patients with hemoglobin (Hgb) levels between ≥ 9 g/dL, and ≤ 10 g/dL, and no urgent need for red blood cell transfusion were included in this retrospective analysis. The aim of cancer treatment was palliative for metastatic patients (36 out of 63), or adjuvant or curative for patients with localized disease (27 out of 63). All the patients received 100 mg of iron sucrose which was delivered intravenously in 100 mL of saline solution, infused within 30 min, 5 infusions every other day. Complete blood count, serum iron, and ferritin levels before and at every 1 to 3 months subsequently after iv iron administration were followed regularly.ResultsInitial mean serum Hgb, serum ferritin and serum iron levels were 9.33 g/dL, 156 ng/mL, and 35.9 μg/dL respectively. Mean Hgb, ferritin, and iron levels 1 to 3 months, and 6 to 12 months after iv iron administration were 10.4 g/dL, 11.2 g/dL, 298.6 ng/mL, 296.7 ng/mL, and 71.6 μg/dL, 67.7 μg/dL respectively with a statistically significant increase in the levels (p < 0.001). Nineteen patients (30 %) however had further decrease in Hgb levels despite iv iron administration, and blood transfusion was necessary in 18 of these 19 patients (28.5 %). The 1-year overall survival rates differed in metastatic cancer patients depending on their response to iv iron; 61.1 % in responders versus 35.3 % in non-responders, (p = 0.005), furthermore response to iv iron correlated with tumor response to cancer treatment, and this relation was statistically significant, (p < 0.001).ConclusionsIv iron administration in cancer patients undergoing active oncologic treatment is an effective and safe measure for correction of anemia, and prevention of worsening of anemia. Amelioration of anemia and increase in Hgb levels with iv iron administration in patients with disseminated cancer is associated with increased tumor response to oncologic treatment and overall survival. Response to iv iron may be both a prognostic and a predictive factor for response to cancer treatment and survival.
Highlights
Anemia is a major cause of morbidity in patients with cancer resulting in poor physical performance, prognosis and therapy outcome
Intravenous iron use in cancer related anemia has been popularized with the approval of erythropoiesis-stimulating agents in 1997 in oncology, and iv iron was shown to enhance the response to erythropoietin [5, 9, 11]
We demonstrated a close relation between response to iv iron and response to cancer treatment
Summary
Anemia is a major cause of morbidity in patients with cancer resulting in poor physical performance, prognosis and therapy outcome. Besides all the reasons mentioned above, probably the most important one for the development of cancer associated anemia is the presence of chronic inflammatory state and release of inflammatory cytokines related to the tumor itself [1,2,3,4]. These cytokines such as interleukin-6 result in erythroid progenitor cell suppression, impaired erythropoietin production, impaired iron utilization and decreased half-life of red blood cells [3, 5, 6]. Hepcidin controls iron absorption from the gut, the recycling of iron derived from senescent and damaged erythrocytes, and the release of iron from tissue stores [5, 6]
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