How I treat cancer-associated anemia

Gilreath, Jeffrey A.; Rodgers, George M.

doi:10.1182/blood.2019004017

Cited by 68 publications

(88 citation statements)

References 108 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…None of the 57 patients met criteria for this condition using a TSAT less than 20% and serum ferritin greater than 100 ng/mL. 26 These data become especially poignant with the advent of four formulations of intravenous iron which permit a complete or near-complete replacement dose in a single visit over 15 to 60 minutes. In a cohort of 888 oral iron-intolerant, iron-deficient patients who received 1288 doses of 1000 mg of low molecular weight iron dextran (LMWID) in 1 hour, 76% were reported to have an Hb increase of 1 to 2 g in 4 weeks.…”

Section: Discussionmentioning

confidence: 99%

Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy

Auerbach

Staffa

Brugnara

2021

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Objective: To assess the accuracy of a simplified approach for the diagnosis of iron deficiency anemia (IDA) based on the complete blood cell count (CBC) and reticulocyte analysis. Patients and Methods: Five hundred fifty-six consecutive, nonselected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. Complete blood count, serum ferritin, iron, and transferrin saturation were performed as clinically indicated. Reticulocyte hemoglobin equivalent was measured with a Sysmex XN-450 analyzer on the residual CBC sample. The study period was from September 20, 2017, through and including November 15, 2018. Results: Patients (N¼556) were studied at baseline, of whom 150 were subsequently treated with intravenous iron. Receiver operating characteristic analysis yielded an RET-He cut-off of 30.7 pg to identify IDA (area under curve, 0.733; 95% CI, 0.692 to 0.775), with 68.2% sensitivity and 69.7% specificity. Patients (n¼240) were seen at follow-up, with 57 treated and 183 not treated with intravenous iron. Responsiveness was defined as a hemoglobin increase of 1.0 g: a combination of RET-He <28.5 pg and hemoglobin value <10.3 g/dL had 84% sensitivity and 78% specificity as response predictor (area under the curve, 0.749; 95% CI, 0.622 to 0.875). Conclusion: Data from CBC and RET-He can identify patients with IDA, determine need for and responsiveness to intravenous iron, and reduce time for therapeutic decisions. Limitations of this study are uncontrolled design, its single-site and retrospective nature, and that it requires prospective validation.

show abstract

Section: Discussionmentioning

confidence: 99%

Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy

Auerbach

Staffa

Brugnara

2021

Mayo Clinic Proceedings

View full text Add to dashboard Cite

show abstract

“…Patients with breast cancer and other malignant diseases often develop functional iron deficiency or overt anemia as a consequence of their underlying disease (10,11,48). Anemia per se may negatively affect cardiovascular function and quality A B of life in affected patients, so that physicians frequently see the necessity to correct anemia by different treatments (34,35). Intravenous iron administration is one of the treatment options for ACD in oncologic patients specifically if they suffer from absolute iron deficiency with low serum ferritin levels (49) which often coexists based on chronic blood losses and which aggravates the severity of ACD (50,51).…”

Section: Discussionmentioning

confidence: 99%

“…In spite of the direct effects of iron on tumor cells and antitumor immunity, the impact of intravenous iron preparations used for treatment of cancer related anemia towards the further clinical course and outcome of cancer along with their impact on specific cancer therapy is still unknown (34,35). On the one hand, the functional iron deficiency caused by tumoraccompanying inflammation may be regarded as a measure to limit tumor progression, on the other hand, iron deficiency and ACD may result in suboptimal delivery of iron needed for immune cell function.…”

Section: Introductionmentioning

confidence: 99%

Iron Supplementation Interferes With Immune Therapy of Murine Mammary Carcinoma by Inhibiting Anti-Tumor T Cell Function

et al. 2020

View full text Add to dashboard Cite

Iron is both, an essential compound for many metabolic processes, and iron deficiency can impact on the proliferation of cells including lymphocytes but also tumor cells. On the other hand, excess iron-catalyzed radical formation can induce cellular toxicity which has been previously demonstrated for T cells in hereditary iron overload. Despite these interconnections, little is known on the effects of clinically approved intravenous iron supplements for curing cancer-related anemia, on T cell differentiation, tumor proliferation, anti-tumor T cell responses and, of clinical importance, on efficacy of cancer immunotherapies. Herein, we analyzed the effects of intravenous iron supplementation on T cell function and on the effectiveness of anti-cancer chemotherapy with IL-2/doxorubicin or immunotherapy with checkpoint-inhibitor anti-PD-L1 in C57Bl/6N female mice with implanted E0771 mammary carcinomas. We found that iron application resulted to an increased availability of iron in the tumor microenvironment and stimulation of tumor growth. In parallel, iron application inhibited the activation, expansion and survival of cytotoxic CD8+ T cells and of CD4+ T helper cells type 1 and significantly reduced the efficacy of the investigated anti-cancer treatments. Our results indicate that iron administration has a tumor growth promoting effect and impairs anti-cancer responses of tumor infiltrating T lymphocytes along with a reduced efficacy of anti-cancer therapies. Iron supplementation in cancer patients, especially in those treated with immunotherapies in a curative setting, may be thus used cautiously and prospective studies have to clarify the impact of such intervention on the outcome of patients.

show abstract

“…31,50,51 Evaluations of parameters related to iron metabolism (serum iron, ferritin, transferrin saturation percentage, and hepcidin, if possible) permits the detection of an iron deficiency (ID) or FID. 52 Finally, the Glasgow Prognostic Score (GPS), obtained by the ratio between inflammation (CRP) and nutritional status (albumin), is of great value to clinicians, as it reflects the systemic inflammatorynutritional status of patients 53 and is correlated with the severity of anemia. 31 Treatments for anemia in patients with cancer aim to restore hemoglobin concentrations and red blood cell counts and thus to optimize blood and tissue oxygenation, resulting in improvements in energy and fatigue.…”

Section: Therapeutic Approaches For Anemia In Patients With Cancermentioning

confidence: 99%

Experimental Drugs for Chemotherapy- and Cancer-Related Anemia

Madeddu¹,

Neri²,

Sanna³

et al. 2021

JEP

View full text Add to dashboard Cite

Anemia in cancer patients is a relevant condition complicating the course of the neoplastic disease. Overall, we distinguish the anemia which arises under chemotherapy as pure adverse event of the toxic effects of the drugs used, and the anemia induced by the tumour-associated inflammation, oxidative stress, and systemic metabolic changes, which can be worsened by the concomitant anticancer treatments. This more properly cancer-related anemia depends on several overlapping mechanism, including impaired erythropoiesis and functional iron deficiency, which make its treatment more difficult. Standard therapies approved and recommended for cancer anemia, as erythropoiesis-stimulating agents and intravenous iron administration, are limited to the treatment of chemotherapy-induced anemia, preferably in patients with advanced disease, in view of the still unclear effect of erythropoiesis-stimulating agents on tumour progression and survival. Outside the use of chemotherapy, there are no recommendations for the treatment of cancer-related anemia. For a more complete approach, it is fundamentally a careful evaluation of the type of anemia and iron homeostasis, markers of inflammation and changes in energy metabolism. In this way, anemia management in cancer patient would permit a tailored approach that could give major benefits. Experimental drugs targeting hepcidin and activin II receptor pathways are raising great expectations, and future clinical trials will confirm their role as remedies for cancer-related anemia. Recent evidence on the effect of integrated managements, including nutritional support, antioxidants and anti-inflammatory substances, for the treatment of cancer anemia are emerging. In this review article, we show standard, innovative, and experimental treatment used as remedy for anemia in cancer patients.

show abstract

How I treat cancer-associated anemia

Cited by 68 publications

References 108 publications

Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy

Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy

Iron Supplementation Interferes With Immune Therapy of Murine Mammary Carcinoma by Inhibiting Anti-Tumor T Cell Function

Experimental Drugs for Chemotherapy- and Cancer-Related Anemia

Contact Info

Product

Resources

About