Iron Deficiency Anemia in Patients Undergoing Extracorporeal Photopheresis for Cutaneous T-Cell Lymphoma

Sanford, Kimberly W.; Anderson, Jennifer M.; Roseff, Susan D.; McPherson, Richard A.

doi:10.1093/labmed/lmy034

Cited by 13 publications

(36 citation statements)

References 11 publications

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“…None of these reports elaborated on the etiology of the anemia nor described how to manage it. More recently, a report on 35 patients with CTCL treated with long‐term ECP identified iron deficiency anemia (IDA) in 49% of patients, thought secondary to equipment‐related blood loss . With the currently available FDA‐approved ECP devices, adequate red cell mass is necessary to harvest the WBC for treatment.…”

Section: Introductionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

“…This may be due in part to the fact that a majority of our patients had undergone an allogeneic hematopoietic stem cell transplant with associated potential for transfusional iron overload from their pre‐ and peri‐transplant periods. Although the mechanism for this potential adverse effect is not clearly understood at this time, our prevailing hypothesis concurs with that of Sanford and colleagues: chronic blood loss with each ECP session results in chronic iron depletion and resultant IDA …”

Section: Discussionmentioning

confidence: 99%

“…Our cumulative incidence of IDA falls in the range of anemia or increased need for transfusion previously reported in patients receiving ECP (range zero to 49%), and adds to the limited body of evidence that suggests IDA is a potential complication of ECP. [5][6][7][8][9][10][11][12][13] We focused on IDA specifically; more than half of our patients were anemic at the onset of ECP therapy, although not all of those patients subsequently presented with markers of iron deficiency. This may be due in part to the fact that a majority of our patients had undergone an allogeneic hematopoietic stem cell transplant with associated potential for transfusional iron overload from their preand peri-transplant periods.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, a report on 35 patients with CTCL treated with long-term ECP identified iron deficiency anemia (IDA) in 49% of patients, thought secondary to equipment-related blood loss. 13 With the currently available FDA-approved ECP devices, adequate red cell mass is necessary to harvest the WBC for treatment. The presence of anemia therefore may result in ECP therapy delays and/or subject the patient to the risks associated with blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

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Iron deficiency anemia associated with extracorporeal photopheresis: A retrospective analysis

Kuhn

Bartoo

Dierkhising

et al. 2019

J of Clinical Apheresis

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Background Extracorporeal photopheresis (ECP) is associated with few adverse effects. We have anecdotally noted patients treated with long‐term ECP develop iron deficiency anemia (IDA). Methods We performed a retrospective chart review of adult patients who received ECP for any indication at Mayo Clinic Rochester and Mayo Clinic Arizona. The primary objective was to describe the cumulative incidence of IDA at 1 year of ECP therapy. Results A total of 123 patients were eligible for analysis. Graft‐vs‐host disease was the most common indication for ECP (n = 76, 61.8%). At 1 year of ECP therapy, the cumulative incidence of IDA was 24.1% (95% CI, 14.2%‐32.9%). At 5 years, the cumulative incidence of IDA was 68.3% (95% CI, 38%‐83.8%). Risk factors for the development of IDA included: cumulative number of ECP sessions (HR 1.34, 95% CI, 1.05‐1.73 per 10 additional sessions, P = .022), an indication for ECP of solid organ transplant rejection (compared to cutaneous T‐cell lymphoma, HR 5.46, 95% CI, 2.06‐14.49, P < .001), and proton pump inhibitor use at baseline (HR 2.15, 95% CI, 1.1‐4.21, P = .03). Iron supplementation was initiated in 29 of 37 evaluable patients who developed IDA, with a cumulative incidence of supplementation in 77.2% patients within 3 months of recognition of IDA (95% CI, 55.8%‐88.3%). Hemoglobin normalized in 50.1% of patients started on iron supplementation for IDA within 7 months (95% CI, 25.2%‐66.7%). Conclusions Iron deficiency anemia is common in patients receiving long‐term ECP and occurs throughout ECP therapy. IDA resolved with iron supplementation in half of patients.

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Section: Introductionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Iron deficiency anemia associated with extracorporeal photopheresis: A retrospective analysis

Kuhn

Bartoo

Dierkhising

et al. 2019

J of Clinical Apheresis

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Mycosis fungoides and Sézary syndrome: 2019 update on diagnosis, risk‐stratification, and management

2019

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Disease Overview: Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). Diagnosis:The diagnosis of MF or SS requires the integration of clinical and histopathologic data.Risk-Adapted Therapy: TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, skin-directed therapies are preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies. These include biologic-response modifiers, histone deacetylase (HDAC) inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.

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Cutaneous T‐cell lymphomas: 2021 update on diagnosis, risk‐stratification, and management

Hristov¹,

Tejasvi

Wilcox

2021

American J Hematol

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Disease overview: Cutaneous T-cell lymphomas are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). Diagnosis: The diagnosis of MF or SS requires the integration of clinical and histopathologic data.Risk-adapted therapy: TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both diseasespecific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies, including biologic-response modifiers, histone deacetylase inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.

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Iron Deficiency Anemia in Patients Undergoing Extracorporeal Photopheresis for Cutaneous T-Cell Lymphoma

Abstract: Chronic ECP led to IDA in 28 of 35 patients with CTCL. IDA occurs due to blood loss when ECP equipment does not return full blood volume to patients.

Cited by 13 publications

References 11 publications

Iron deficiency anemia associated with extracorporeal photopheresis: A retrospective analysis

Iron deficiency anemia associated with extracorporeal photopheresis: A retrospective analysis

Mycosis fungoides and Sézary syndrome: 2019 update on diagnosis, risk‐stratification, and management

Cutaneous T‐cell lymphomas: 2021 update on diagnosis, risk‐stratification, and management

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