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Tilman Steinmetz H. Take into Account Variations of Transferrin Saturation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:427. [PMID: 36106878 PMCID: PMC9533701 DOI: 10.3238/arztebl.m2022.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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2
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Sun X, Li J, He Q, Xue Y, Bai Y, Yang Y, Wang X, Wang S, Li R. Ferric ion detection mechanism of a dicarboxylic cellulose nanocrystal and a 7-amino-4-methylcoumarin based fluorescent chemosensor. RSC Adv 2022; 12:16798-16804. [PMID: 35754908 PMCID: PMC9170515 DOI: 10.1039/d2ra02303b] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/01/2022] [Indexed: 12/13/2022] Open
Abstract
As one of Earth's most widely distributed and abundant elements, iron impacts the natural environment and biological systems. Therefore, developing a simple, rapid, and accurate Fe3+ detection method is vital. Fluorescent dicarboxylic cellulose nanocrystals (FDCN) with selective quenching of Fe3+ were synthesized using 7-amino-4-methylcoumarin (AMC), and dicarboxylic cellulose nanocrystals (DCN) prepared by sequential periodate-chlorite oxidation. The sensing characteristics and detection mechanism of FDCN for Fe3+ were studied by fluorescence spectrophotometry, Fourier-transform infrared spectroscopy (FTIR), the Stern-Volmer equation, Job's plot method, and the Benesi-Hildebrand equation. The results showed that FDCN was highly selective for Fe3+, and other metal ions did not reduce the selectivity. High sensitivity with a detection limit of 0.26 μM and a Stern-Volmer quenching constant of 0.1229 were also achieved. The coordination between Fe3+ and the carboxylic, hydroxyl, and amide groups on the surface of FDCN and the carbonyl of coumarin lactones to form FDCN/Fe3+ complexes prevented the intramolecular charge transfer (ICT) process and led to the fluorescence quenching of FDCN. EDTA restored the fluorescence emission of quenched FDCN. The complexation stoichiometry of Fe3+ to FDCN was 1 : 1, and the association constant was 3.23 × 104 M-1. The high hydrophilicity, sensitivity, and selectivity of FDCN for Fe3+ make the chemosensor suitable for Fe3+ trace detection in drinking water and biology.
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Affiliation(s)
- Xiaozheng Sun
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
| | - Jianye Li
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
| | - Qiang He
- College of Mechanical Engineering, Jiamusi University No. 258 Xuefu Street Jiamusi 154007 China
| | - Yanhua Xue
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
| | - Yu Bai
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
| | - Yuyao Yang
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
| | - Xiaogang Wang
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
| | - Sun Wang
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
| | - Rui Li
- College of Engineering, Northeast Agricultural University No. 600 Changjiang Street Harbin 150030 China
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3
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Weiler S, Nairz M. TAM-ing the CIA-Tumor-Associated Macrophages and Their Potential Role in Unintended Side Effects of Therapeutics for Cancer-Induced Anemia. Front Oncol 2021; 11:627223. [PMID: 33842333 PMCID: PMC8027083 DOI: 10.3389/fonc.2021.627223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/01/2021] [Indexed: 12/21/2022] Open
Abstract
Cancer-induced anemia (CIA) is a common consequence of neoplasia and has a multifactorial pathophysiology. The immune response and tumor treatment, both intended to primarily target malignant cells, also affect erythropoiesis in the bone marrow. In parallel, immune activation inevitably induces the iron-regulatory hormone hepcidin to direct iron fluxes away from erythroid progenitors and into compartments of the mononuclear phagocyte system. Moreover, many inflammatory mediators inhibit the synthesis of erythropoietin, which is essential for stimulation and differentiation of erythroid progenitor cells to mature cells ready for release into the blood stream. These pathophysiological hallmarks of CIA imply that the bone marrow is not only deprived of iron as nutrient but also of erythropoietin as central growth factor for erythropoiesis. Tumor-associated macrophages (TAM) are present in the tumor microenvironment and display altered immune and iron phenotypes. On the one hand, their functions are altered by adjacent tumor cells so that they promote rather than inhibit the growth of malignant cells. As consequences, TAM may deliver iron to tumor cells and produce reduced amounts of cytotoxic mediators. Furthermore, their ability to stimulate adaptive anti-tumor immune responses is severely compromised. On the other hand, TAM are potential off-targets of therapeutic interventions against CIA. Red blood cell transfusions, intravenous iron preparations, erythropoiesis-stimulating agents and novel treatment options for CIA may interfere with TAM function and thus exhibit secondary effects on the underlying malignancy. In this Hypothesis and Theory, we summarize the pathophysiological hallmarks, clinical implications and treatment strategies for CIA. Focusing on TAM, we speculate on the potential intended and unintended effects that therapeutic options for CIA may have on the innate immune response and, consequently, on the course of the underlying malignancy.
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Affiliation(s)
- Stefan Weiler
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland.,Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, Eidgenossische Technische Hochschule Zurich, Zurich, Switzerland
| | - Manfred Nairz
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
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Aksan A, Farrag K, Aksan S, Schroeder O, Stein J. Flipside of the Coin: Iron Deficiency and Colorectal Cancer. Front Immunol 2021; 12:635899. [PMID: 33777027 PMCID: PMC7991591 DOI: 10.3389/fimmu.2021.635899] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Iron deficiency, with or without anemia, is the most frequent hematological manifestation in individuals with cancer, and is especially common in patients with colorectal cancer. Iron is a vital micronutrient that plays an essential role in many biological functions, in the context of which it has been found to be intimately linked to cancer biology. To date, however, whereas a large number of studies have comprehensively investigated and reviewed the effects of excess iron on cancer initiation and progression, potential interrelations of iron deficiency with cancer have been largely neglected and are not well-defined. Emerging evidence indicates that reduced iron intake and low systemic iron levels are associated with the pathogenesis of colorectal cancer, suggesting that optimal iron intake must be carefully balanced to avoid both iron deficiency and iron excess. Since iron is vital in the maintenance of immunological functions, insufficient iron availability may enhance oncogenicity by impairing immunosurveillance for neoplastic changes and potentially altering the tumor immune microenvironment. Data from clinical studies support these concepts, showing that iron deficiency is associated with inferior outcomes and reduced response to therapy in patients with colorectal cancer. Here, we elucidate cancer-related effects of iron deficiency, examine preclinical and clinical evidence of its role in tumorigenesis, cancer progression and treatment response. and highlight the importance of adequate iron supplementation to limit these outcomes.
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Affiliation(s)
- Aysegül Aksan
- Institute of Nutritional Science, Justus-Liebig University, Giessen, Germany.,Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt, Germany.,Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany
| | - Karima Farrag
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Sami Aksan
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Oliver Schroeder
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Jürgen Stein
- Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt, Germany.,Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
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5
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Reticulocyte Hemoglobin Content (Ret He): A Simple Tool for Evaluation of Iron Status in Childhood Cancer. J Pediatr Hematol Oncol 2020; 42:e147-e151. [PMID: 31851071 DOI: 10.1097/mph.0000000000001700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer-related anemia is a common complication of cancer and its treatment that may be mediated by nutritional deficiency or inflammatory cytokines inhibiting erythropoiesis. AIM We evaluated the value of reticulocyte hemoglobin content (Ret He) as a marker of iron availability for erythropoiesis in childhood cancer and the impact of oral iron supplementation on hematologic parameters in patients with low Ret He. MATERIALS AND METHODS This prospective study included 100 pediatric patients with cancer on chemotherapy who were screened for the presence of anemia. Patients with anemia underwent testing for complete blood count including Ret He on Sysmex XE 2100 and assessment of reticulocyte count, serum iron, serum ferritin, transferrin saturation, total iron-binding capacity, and C-reactive protein. Patients were classified according to their level of Ret He into normal or low Ret He using a cutoff level of 28 pg. Patients with low Ret He were subjected to 6 weeks' treatment with oral ion and were followed up with complete blood count and iron profile. RESULTS Thirty-one (77.5%) patients had normal Ret He, and 9 (22.5%) had low Ret He. Ret He was positively correlated with red cell indices, but not with iron parameters. After oral iron supplementation, a significant increase in hemoglobin, reticulocyte count, and iron was found. CONCLUSIONS We suggest that Ret He could be used as an easy and affordable tool for the assessment of iron deficiency anemia in childhood cancer during chemotherapy treatment. A trial of oral iron in patients with low Ret He may be useful to correct the associated anemia.
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Aapro M, Beguin Y, Bokemeyer C, Dicato M, Gascón P, Glaspy J, Hofmann A, Link H, Littlewood T, Ludwig H, Österborg A, Pronzato P, Santini V, Schrijvers D, Stauder R, Jordan K, Herrstedt J. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv96-iv110. [PMID: 29471514 DOI: 10.1093/annonc/mdx758] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- M Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Y Beguin
- University of Liège, Liège
- CHU of Liège, Liège, Belgium
| | - C Bokemeyer
- Department of Oncology, Hematology and BMT with Section Pneumology, University of Hamburg, Hamburg, Germany
| | - M Dicato
- Hématologie-Oncologie, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - P Gascón
- Department of Haematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - J Glaspy
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - A Hofmann
- Medical Society for Blood Management, Laxenburg, Austria
| | - H Link
- Klinik für Innere Medizin I, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - T Littlewood
- Department of Haematology, John Radcliffe Hospital, Oxford, UK
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - A Österborg
- Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
| | - P Pronzato
- Medica Oncology, IRCCS Asiana Pedaliter Universitaria San Martino - IST, Institutor Nazionale per la Ricercars sol Chancre, Genova
| | - V Santini
- Department of Experimental and Clinical Medicine, Haematology, University of Florence, Florence, Italy
| | - D Schrijvers
- Department of Medical Oncology, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - R Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - K Jordan
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Herrstedt
- Department of Oncology, Zealand University Hospital Roskilde, Roskilde
- University of Copenhagen, Copenhagen, Denmark
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7
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Antianemic Treatment of Cancer Patients in German Routine Practice: Data from a Prospective Cohort Study-The Tumor Anemia Registry. Anemia 2016; 2016:8057650. [PMID: 26966573 PMCID: PMC4757729 DOI: 10.1155/2016/8057650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/03/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022] Open
Abstract
The aim of this prospective cohort study was to assess current antianemic treatment of cancer patients in German routine practice, including diagnostics, treatments, and quality of life (QoL). 88 study sites recruited 1018 patients at the start of antianemic treatment with hemoglobin (Hb) levels <11 g/dL (females) or <12 g/dL (males). Patients were followed up for 12 weeks. 63% of the patients had inoperable solid tumors, 22% operable solid tumors, and 15% hematological malignancies. Over 85% received chemotherapy. Median age was 67 years; 48% were male. Red blood cell transfusions (RBCTx) were given to 59% of all patients and to 55% of the patients with Hb ≥8 g/dL on day 1 of the observation period (day 1 treatment). Erythropoiesis-stimulating agents (ESAs) were the second most frequently applied day 1 treatment (20%), followed by intravenous (IV) iron (15%) and ESA + IV iron (6%). Only about a third of patients were tested for blood serum iron parameters at the start of treatment. Overall, more than half of the patients had long-term responses to antianemic therapy. Our data suggest that in routine practice diagnostics for treatable causes of anemia are underused. A high proportion of cancer patients receive RBCTx. It should be discussed whether thorough diagnostics and earlier intervention could decrease the need for RBCTx. This trial is registered with NCT01795690.
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Ludwig H, Evstatiev R, Kornek G, Aapro M, Bauernhofer T, Buxhofer-Ausch V, Fridrik M, Geissler D, Geissler K, Gisslinger H, Koller E, Kopetzky G, Lang A, Rumpold H, Steurer M, Kamali H, Link H. Iron metabolism and iron supplementation in cancer patients. Wien Klin Wochenschr 2015; 127:907-19. [PMID: 26373748 PMCID: PMC4679104 DOI: 10.1007/s00508-015-0842-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/29/2015] [Indexed: 12/21/2022]
Abstract
Iron deficiency and iron deficiency-associated anemia are common complications in cancer patients. Most iron deficient cancer patients present with functional iron deficiency (FID), a status with adequate storage iron, but insufficient iron supply for erythroblasts and other iron dependent tissues. FID is the consequence of the cancer-associated cytokine release, while in absolute iron deficiency iron stores are depleted resulting in similar but often more severe symptoms of insufficient iron supply. Here we present a short review on the epidemiology, pathophysiology, diagnosis, clinical symptoms, and treatment of iron deficiency in cancer patients. Special emphasis is given to intravenous iron supplementation and on the benefits and limitations of different formulations. Based on these considerations and recommendations from current international guidelines we developed recommendations for clinical practice and classified the level of evidence and grade of recommendation according to the principles of evidence-based medicine.
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Affiliation(s)
- Heinz Ludwig
- c/o 1. Medizinische Abteilung, Zentrum für Onkologie, Wilhelminen-Krebsforschungsinstitut, Wilhelminenspital, Montleartstraße 37, 1160, Wien, Austria.
| | - Rayko Evstatiev
- Universitätsklinik für Innere Medizin III, MedUni, Wien, Austria
| | - Gabriela Kornek
- Universitätsklinik für Innere Medizin I, MedUni, Wien, Austria
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie IMO, Clinique de Genolier, Genolier, Switzerland
| | | | | | | | - Dietmar Geissler
- 1. Medizinische Abteilung, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Klaus Geissler
- 5. Medizinische Abteilung, Krankenhaus Hietzing, Wien, Austria
| | | | | | - Gerhard Kopetzky
- 1. Medizinische Abteilung, Landesklinikum St. Pölten, Pölten, Austria
| | - Alois Lang
- Abteilung für Innere Medizin, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Holger Rumpold
- Abteilung für Interne 1, Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | - Michael Steurer
- Universitätsklinik für Innere Medizin V, MedUni Innsbruck, Innsbruck, Austria
| | | | - Hartmut Link
- Medizinische Klinik I, Westpfalz-Klinikum, Kaiserslautern, Germany
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Toledano A, Luporsi E, Morere JF, Scotté F, Laribi K, Barrière J, Huot-Marchand P, Duvillié L, Concas VH, Bugat R. Clinical use of ferric carboxymaltose in patients with solid tumours or haematological malignancies in France. Support Care Cancer 2015; 24:67-75. [DOI: 10.1007/s00520-015-2728-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/29/2015] [Indexed: 12/18/2022]
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Peerschke EIB, Pessin MS, Maslak P. Using the hemoglobin content of reticulocytes (RET-He) to evaluate anemia in patients with cancer. Am J Clin Pathol 2014; 142:506-12. [PMID: 25239418 DOI: 10.1309/ajcpcvz5b0boyjgn] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Evaluation of anemia, particularly iron deficiency, in patients with cancer is difficult. This study examined using the hemoglobin content of reticulocytes (RET-He) to rule out iron deficiency, as defined by serum iron studies (transferrin saturation <20%, serum iron <40 μg/dL, and ferritin <100 ng/mL), in an unselected cancer patient population. METHODS Patients were entered into the study based on the existence of concurrent laboratory test requests for CBC and serum iron studies. RESULTS Using a threshold of 32 pg/cell, RET-He ruled out iron deficiency with a negative predictive value (NPV) of 98.5% and 100%, respectively, in the study population (n = 209) and in a subpopulation of patients with low reticulocyte counts (n = 19). In comparison, the NPV of traditional CBC parameters (hemoglobin, <11 g/dL; mean corpuscular volume, <80 fL) was only 88.5%. CONCLUSIONS These results support the use of RET-He in the evaluation of iron deficiency in a cancer care setting.
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Affiliation(s)
- Ellinor I. B. Peerschke
- Memorial Sloan-Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Peter Maslak
- Memorial Sloan-Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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Macciò A, Madeddu C, Gramignano G, Mulas C, Tanca L, Cherchi MC, Floris C, Omoto I, Barracca A, Ganz T. The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study. Haematologica 2014; 100:124-32. [PMID: 25239265 DOI: 10.3324/haematol.2014.112813] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Anemia in oncology patients is often considered a side effect of cancer therapy; however, it may occur before any antineoplastic treatment (cancer-related anemia). This study was aimed to evaluate the prevalence of cancer-related anemia in a large cohort of oncology patients and whether inflammation and malnutrition were predictive of its development and severity. The present study included 888 patients with cancer at different sites between May 2011 and January 2014. Patients were assessed at diagnosis before any cancer treatment. The prevalence of anemia according to the main clinical factors (tumor site, stage and performance status) was analyzed. In each patient markers of inflammation, iron metabolism, malnutrition and oxidative stress as well as the modified Glasgow prognostic score, a combined index of malnutrition and inflammation, were assessed and their role in predicting hemoglobin level was evaluated. The percentage of anemic patients was 63% with the lowest hemoglobin levels being found in the patients with most advanced cancer and compromised performance status. Hemoglobin concentration differed by tumor site and was lowest in patients with ovarian cancer. Hemoglobin concentration was inversely correlated with inflammatory markers, hepcidin, ferritin, erythropoietin and reactive oxygen species, and positively correlated with leptin, albumin, cholesterol and antioxidant enzymes. In multivariate analysis, stage, interleukin-6 and leptin were independent predictors of hemoglobin concentration. Furthermore, hemoglobin was inversely dependent on modified Glasgow Prognostic Score. In conclusion, cancer-related anemia is a multifactorial problem with immune, nutritional and metabolic components that affect its severity. Only a detailed assessment of the pathogenesis of cancer-related anemia may enable clinicians to provide safe and effective individualized treatment.
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Affiliation(s)
- Antonio Macciò
- Department of Gynecological Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy
| | - Clelia Madeddu
- Department of Medical Science "Mario Aresu", University of Cagliari, Italy
| | | | - Carlo Mulas
- Medical Oncology Unit, Sirai Hospital, Carbonia, Italy
| | - Luciana Tanca
- Department of Medical Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy
| | - Maria Cristina Cherchi
- Department of Medical Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy
| | - Carlo Floris
- Medical Oncology Unit, "Nuova Casa di Cura", Decimomannu, Cagliari, Italy
| | - Itaru Omoto
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Antonio Barracca
- Department of Gynecological Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Steinmetz T, Kindler M, Lange O, Vehling-Kaiser U, Kuhn A, Hellebrand E. A prospective cohort study on the impact of darbepoetin alfa on quality of life in daily practice following anemia treatment guideline revisions. Curr Med Res Opin 2014; 30:1813-20. [PMID: 24849527 DOI: 10.1185/03007995.2014.924914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of darbepoetin alfa (DA) on hemoglobin (Hb) levels and quality of life (QoL) in cancer patients with anemia in current daily practice following several revisions of anemia treatment guidelines. METHODS This was a prospective, multi-center, observational study across Germany in non-myeloid cancer outpatients with chemotherapy-induced anemia treated with DA. Age, sex, cancer type, stage, and therapy, performance status, anemia status and treatment, and Hb concentrations were recorded for up to 18 weeks in a web-based registry. Optional QoL assessments were collected at baseline and at the end of DA treatment. MAIN RESULTS Of 984 eligible patients, 978 had complete anemia data, 492 also had complete QoL data. In the 978 patients, mean age was 64 (standard deviation, SD 12) years, 62% of patients were women. Breast (26%) and gastrointestinal (22%) cancer were most prevalent. Therapy was palliative in 44% of patients and initiated with curative intent in 29%. Mean baseline Hb was 9.5 (SD 0.9) g/dL, which increased by an average of 1.2 g/dL. In 67% of patients Hb increased either to 10-12 g/dL or by ≥2 g/dL; no Hb response was seen in 219 patients (22%); increases of 0 to 1, >1 to 2, and >2 g/dl were seen in 216 (22%), 265 (27%), and 278 (28%) patients, respectively. Anemia treatment did not result in any significant differences of performance status. However, QoL improvements were significantly greater in Hb responders, although a linear relationship with Hb increments was lacking. None of 47 fatal cases was considered related to treatment with DA. CONCLUSION Patients treated with DA in routine clinical practice had increases in Hb and reported improvement in QoL. Due to the uncontrolled design, no conclusions can be made regarding causality to treatment and the clinical relevance of the improvement.
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Affiliation(s)
- T Steinmetz
- Oncology outpatient clinic , Cologne , Germany
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13
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Mirlohi S, Duncan SE, Harmon M, Case D, Lesser G, Dietrich AM. Analysis of salivary fluid and chemosensory functions in patients treated for primary malignant brain tumors. Clin Oral Investig 2014; 19:127-37. [PMID: 24595687 PMCID: PMC4156565 DOI: 10.1007/s00784-014-1211-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 02/05/2014] [Indexed: 12/05/2022]
Abstract
Objectives The frequency and causes of chemosensory (taste and smell) disorders in cancer patients remain under-reported. This study examined the impact of cancer therapy on taste/smell functions and salivary constituents in brain tumor patients. Materials and methods Twenty-two newly diagnosed patients with primary malignant gliomas underwent 6 weeks of combined modality treatment (CMD) with radiation and temozolomide followed by six monthly cycles of temozolomide. Chemosensory functions were assessed at 0, 3, 6, 10, 18, and 30 weeks with paired samples of saliva collected before and after an oral rinse with ferrous-spiked water. Iron (Fe)-induced oxidative stress was measured by salivary lipid oxidation (SLO); salivary proteins, electrolytes, and metals were determined. Parallel salivary analyses were performed on 22 healthy subjects. Results Chemosensory complaints of cancer patients increased significantly during treatment (p = 0.04) except at 30 weeks. Fe-induced SLO increased at 10 and 18 weeks. When compared with healthy subjects, SLO, total protein, Na, K, Cu, P, S, and Mg levels, as averaged across all times, were significantly higher (p < 0.05), whereas salivary Zn, Fe, and oral pH levels were significantly lower in cancer patients (p < 0.05). Neither time nor treatment had a significant impact on these salivary parameters in cancer patients. Conclusions Impact of CMT treatment on chemosensory functions can range from minimal to moderate impairment. Analysis of SLO, metals, and total protein do not provide for reliable measures of chemosensory dysfunctions over time. Clinical relevance Taste and smell functions are relevant in health and diseases; study of salivary constituents may provide clues on the causes of their dysfunctions.
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Affiliation(s)
- Susan Mirlohi
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
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14
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de Castro J, Gascón P, Casas A, Muñoz-Langa J, Alberola V, Cucala M, Barón F. Iron deficiency in patients with solid tumours: prevalence and management in clinical practice. Clin Transl Oncol 2014; 16:823-8. [PMID: 24458881 DOI: 10.1007/s12094-013-1155-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 12/23/2013] [Indexed: 02/01/2023]
Abstract
PURPOSE The objective of the present study was to describe the prevalence and management of anaemia and iron deficiency (ID) in treatment-naïve patients with solid tumours in Spain and the incidence of anaemia over 4 months of cancer treatment in clinical practice. METHODS Multicentre, prospective and observational study in newly diagnosed cancer patients. Data on anaemia and iron parameters and its management were collected prior to the initiation of chemotherapy, at each cycle of chemotherapy and after 4 months of treatment. The main outcomes of the study were the prevalence of anaemia at baseline, its incidence during cancer treatment and the prevalence of absolute ID (AID) and functional ID (FID) prior to chemotherapy initiation. RESULTS A total of 295 patients were included in the study. Anaemia was present at diagnosis in 38.6 % of patients and was treated only in 32.5 % of those. A total of 106 patients (60.2 %) without anaemia at baseline developed anaemia during cancer treatment. Serum ferritin and transferrin saturation data were available for 151 of the patients (51.2 %) included in the study. The overall prevalence of ID was 59 %: 48 patients (31.8 %) presented with AID and 41 patients (27.2 %) presented with FID before starting anti-cancer therapy. Thirty-three of 44 non-anaemic iron-deficient patients did not receive any type of iron supplementation before initiating cancer therapy. CONCLUSIONS Iron parameters are not commonly measured in newly diagnosed cancer patients. A correct evaluation and early management of ID could reduce the incidence of treatment-related anaemia in cancer patients.
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Affiliation(s)
- J de Castro
- Servicio de Oncología Médica, Unidad de Oncología Traslacional, Hospital Universitario La Paz, IDIPAZ, Paseo de la Castellana, 261, 28046, Madrid, Spain,
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Ludwig H, Müldür E, Endler G, Hübl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol 2013; 24:1886-1892. [PMID: 23567147 PMCID: PMC3690908 DOI: 10.1093/annonc/mdt118] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Only limited data on the prevalence of iron deficiency (ID) and its correlation with clinical parameters are available in cancer. ID frequently contributes to the pathogenesis of anemia in patients with cancer and may lead to several symptoms such as impaired physical function, weakness and fatigue. PATIENTS AND METHODS Parameters of iron status and clinical parameters were evaluated in 1528 patients with cancer who presented consecutively within a four-month period at our center. One thousand fifty-three patients had solid tumors and 475 hematological malignancies. RESULTS ID [transferrin saturation (TSAT) < 20%] was noted in 645 (42.6%) of the 1513 patients with TSAT tests available and 500 (33.0%) were anemic. ID rates were highest in pancreatic (63.2%), colorectal (51.9%) and lung cancers (50.7%). Of the 409 iron-deficient patients in whom serum ferritin levels were available additionally to TSAT, 335 (81.9%) presented with functional ID (FID) (TSAT < 20%, serum ferritin ≥30 ng/ml) and 74 (18.1%) with absolute ID. In patients with solid tumors, prevalence of ID correlated with cancer stage at diagnosis (P = 0.001), disease status (P = 0.001) and ECOG performance status (P = 0.005). CONCLUSIONS ID was frequently noted in cancer and was associated with advanced disease, close proximity to cancer therapy, and poor performance status in patients with solid tumors.
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Affiliation(s)
- H Ludwig
- Department of Medicine I, Center for Oncology, Haematology and Palliative Care, Wilhelminenspital, Vienna.
| | - E Müldür
- Department of Medicine I, Center for Oncology, Haematology and Palliative Care, Wilhelminenspital, Vienna
| | - G Endler
- Central Laboratory, Wilhelminenspital, Vienna, Austria
| | - W Hübl
- Central Laboratory, Wilhelminenspital, Vienna, Austria
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Esquerdo Galiana G, Cervera JM, Barrajón E, Juárez A, Llorca C, Díaz N, López A, Peiró R. Association between serum levels of C-reactive protein and response to treatment of chemotherapy-induced anemia in patients with solid tumors: a multicenter, prospective, observational study. Med Oncol 2013; 30:417. [PMID: 23371041 DOI: 10.1007/s12032-012-0417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/09/2012] [Indexed: 11/27/2022]
Abstract
Our objective was to determine the association between C-reactive protein (CRP) levels at initiation of anemia treatment and response in solid tumor patients with chemotherapy (CT)-induced anemia. This was a multicenter, prospective, observational study which included adult patients with solid tumor initiating treatment for CT-induced anemia. Data were collected up to 16 weeks, or until premature discontinuation. We included 98 patients (median age 62.5 years, 64 % males, 57 % with ECOG 0-1, 85.7 % at stages III-IV and 54.1 % undergoing palliative CT). Mean (SD) Hb levels at baseline were 10.3 (0.9) g/dL (85.7 % < 11 g/dL) and median (Q1; Q3) CRP was 16.4 mg/L (3.9; 77.8) (68 % ≥ 5 mg/L). A total of 96 % of patients initiated erythropoiesis-stimulating agents (ESA) and iron supplementation; 4 % initiated iron monotherapy. After a median of 85 days, 65 % of patients had Hb ≥ 11 g/dL (in absence of transfusion) (mean change: +0.86 g/dL, 95 % confidence interval (CI) 0.53-1.19). A total of 8 patients required transfusion. A significant correlation (r = -0.39, p = 0.003) was observed between baseline CRP and final Hb levels. In the multivariate linear regression analysis, the independent predictors of higher final Hb levels were a high baseline Hb (adjusted ß = +0.69 g/dL for each g/dL of baseline Hb, 95 % CI 0.17-1.21) and a low log baseline CRP (-0.62 for each log mg/L, 95 %CI -1.22 to -0.02). Our results suggest that, in patients with solid tumors and CT-induced anemia, high CRP levels at treatment initiation predict a poor response to treatment with ESA and iron, independently from anemia severity at therapy initiation and from other patient and disease characteristics.
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Affiliation(s)
- Gaspar Esquerdo Galiana
- Medical Oncology Service, Hospital Clínica Benidorm, Avda Alfonso Puchades 8, 03501 Benidorm, Alicante, Spain.
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Steinmetz T, Tschechne B, Harlin O, Klement B, Franzem M, Wamhoff J, Tesch H, Rohrberg R, Marschner N. Clinical experience with ferric carboxymaltose in the treatment of cancer- and chemotherapy-associated anaemia. Ann Oncol 2013; 24:475-482. [PMID: 23071262 PMCID: PMC3551483 DOI: 10.1093/annonc/mds338] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/05/2012] [Accepted: 07/12/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Intravenous (i.v.) iron can improve anaemia of chronic disease and response to erythropoiesis-stimulating agents (ESAs), but data on its use in practice and without ESAs are limited. This study evaluated effectiveness and tolerability of ferric carboxymaltose (FCM) in routine treatment of anaemic cancer patients. PATIENTS AND METHODS Of 639 patients enrolled in 68 haematology/oncology practices in Germany, 619 received FCM at the oncologist's discretion, 420 had eligible baseline haemoglobin (Hb) measurements, and 364 at least one follow-up Hb measurement. Data of transfused patients were censored from analysis before transfusion. RESULTS The median total iron dose was 1000 mg per patient (interquartile range 600-1500 mg). The median Hb increase was comparable in patients receiving FCM alone (1.4 g/dl [0.2-2.3 g/dl; N = 233]) or FCM + ESA (1.6 g/dl [0.7-2.4 g/dl; N = 46]). Patients with baseline Hb up to 11.0 g/dl and serum ferritin up to 500 ng/ml benefited from FCM treatment (stable Hb ≥ 11.0 g/dl). Also patients with ferritin >500 ng/ml but low transferrin saturation benefited from FCM treatment. FCM was well tolerated, 2.3% of patients reported putative drug-related adverse events. CONCLUSIONS The substantial Hb increase and stabilisation at 11-12 g/dl in FCM-treated patients suggest a role for i.v. iron alone in anaemia correction in cancer patients.
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Affiliation(s)
- T Steinmetz
- Outpatient Clinic for Oncology and Haematology, Cologne.
| | - B Tschechne
- Klinikum Neustadt am Rübenberge, Neustadt am Rübenberge
| | | | - B Klement
- Vifor Pharma, Glattbrugg, Switzerland
| | | | | | - H Tesch
- Outpatient Clinic, Im Pruefling, Frankfurt
| | | | - N Marschner
- Practice for Oncology and Hematology, Freiburg, German
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Re-evaluation of laboratory predictors of response to current anemia treatment regimens of erythropoiesis stimulating agents in cancer patients. Clin Chem Lab Med 2013; 51:1849-57. [DOI: 10.1515/cclm-2013-0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/10/2013] [Indexed: 11/15/2022]
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Tonia T, Mettler A, Robert N, Schwarzer G, Seidenfeld J, Weingart O, Hyde C, Engert A, Bohlius J. Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev 2012; 12:CD003407. [PMID: 23235597 PMCID: PMC8145276 DOI: 10.1002/14651858.cd003407.pub5] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Anaemia associated with cancer and cancer therapy is an important clinical factor in the treatment of malignant diseases. Therapeutic alternatives are recombinant human erythropoiesis stimulating agents (ESAs) and red blood cell transfusions. OBJECTIVES To assess the effects of ESAs to either prevent or treat anaemia in cancer patients. SEARCH METHODS This is an update of a Cochrane review first published in 2004. We searched the Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE and other databases. Searches were done for the periods 01/1985 to 12/2001 for the first review, 1/2002 to 04/2005 for the first update and to November 2011 for the current update. We also contacted experts in the field and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials on managing anaemia in cancer patients receiving or not receiving anti-cancer therapy that compared the use of ESAs (plus transfusion if needed). DATA COLLECTION AND ANALYSIS Several review authors assessed trial quality and extracted data. One review author assessed quality assessment and extracted data, a second review author checked for correctness. MAIN RESULTS This update of the systematic review includes a total of 91 trials with 20,102 participants. Use of ESAs significantly reduced the relative risk of red blood cell transfusions (risk ratio (RR) 0.65; 95% confidence interval (CI) 0.62 to 0.68, 70 trials, N = 16,093). On average, participants in the ESAs group received one unit of blood less than the control group (mean difference (MD) -0.98; 95% CI -1.17 to -0.78, 19 trials, N = 4,715). Haematological response was observed more often in participants receiving ESAs (RR 3.93; 95% CI 3.10 to 3.71, 31 trials, N = 6,413). There was suggestive evidence that ESAs may improve Quality of Life (QoL). There was strong evidence that ESAs increase mortality during active study period (hazard ratio (HR) 1.17; 95% CI 1.06 to 1.29, 70 trials, N = 15,935) and some evidence that ESAs decrease overall survival (HR 1.05; 95% CI 1.00 to 1.11, 78 trials, N = 19,003). The risk ratio for thromboembolic complications was increased in patients receiving ESAs compared to controls (RR 1.52, 95% CI 1.34 to 1.74; 57 trials, N = 15,498). ESAs may also increase the risk for hypertension (fixed-effect model: RR 1.30; 95% CI 1.08 to 1.56; random-effects model: RR 1.12; 95% CI 0.94 to 1.33, 31 trials, N = 7,228) and thrombocytopenia/haemorrhage (RR 1.21; 95% CI 1.04 to 1.42; 21 trials, N = 4,507). There was insufficient evidence to support an effect of ESA on tumour response (fixed-effect RR 1.02; 95% CI 0.98 to 1.06, 15 trials, N = 5,012). AUTHORS' CONCLUSIONS ESAs reduce the need for red blood cell transfusions but increase the risk for thromboembolic events and deaths. There is suggestive evidence that ESAs may improve QoL. Whether and how ESAs affects tumour control remains uncertain. The increased risk of death and thromboembolic events should be balanced against the potential benefits of ESA treatment taking into account each patient's clinical circumstances and preferences. More data are needed for the effect of these drugs on quality of life and tumour progression. Further research is needed to clarify cellular and molecular mechanisms and pathways of the effects of ESAs on thrombogenesis and their potential effects on tumour growth.
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Affiliation(s)
- Thomy Tonia
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Annette Mettler
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Nadège Robert
- Kantonsspitalapotheke WinterthurPharmacyBrauerstrasse 15WinterthurSwitzerlandCH‐8400
| | - Guido Schwarzer
- Institute of Medical Biometry and Medical Informatics, University Medical Center FreiburgGerman Cochrane CentreStefan‐Meier‐Str. 26FreiburgGermanyD‐79104
| | - Jerome Seidenfeld
- American Society of Clinical OncologyDepartment of Quality and Guidelines1900 Duke Street, Suite 200AlexandriaVAUSA22314
| | | | - Chris Hyde
- University of Exeter Medical School, University of ExeterPeninsula Technology Assessment Group (PenTAG)Veysey BuildingSalmon Pool LaneExeterUKEX2 4SG
| | - Andreas Engert
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Julia Bohlius
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
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Halwachs-Baumann G. Diagnosis of anaemia: old things rearranged. Wien Med Wochenschr 2012; 162:478-88. [PMID: 23135251 DOI: 10.1007/s10354-012-0149-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 09/28/2012] [Indexed: 02/08/2023]
Abstract
Anaemia is one of the most leading causes of morbidity and mortality, as declared by the World Health Organisation. This syndrome is characterised by low haemoglobin levels and nonspecific clinical symptoms such as weakness, fatigue and dyspnoea. The symptoms are unspecific as the underlying causes are heterogeneous. Thus, good knowledge of the useful biomarkers and their correct assignment is needed to allow rapid and targeted diagnosis.
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Affiliation(s)
- Gabriele Halwachs-Baumann
- Department for Laboratory Medicine, Central Hospital Steyr, Sierningerstrasse 170, 4400 Steyr, Austria.
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Aapro M, Österborg A, Gascón P, Ludwig H, Beguin Y. Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron. Ann Oncol 2012; 23:1954-1962. [PMID: 22575608 DOI: 10.1093/annonc/mds112] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic diseases reduce the availability of iron for effective erythropoiesis. This review summarises clinical consequences of iron deficiency (ID) and anaemia in cancer patients, mechanisms how impaired iron homeostasis affects diagnosis and treatment of ID, and data from clinical trials evaluating i.v. iron with or without concomitant erythropoiesis-stimulating agents (ESAs). DESIGN Clinical trial reports were identified in PubMed and abstracts at relevant major congresses. RESULTS Reported prevalence of ID in cancer patients ranges from 32 to 60% and most iron-deficient patients are also anaemic. Randomised clinical trials have shown superior efficacy of i.v. iron over oral or no iron in reducing blood transfusions, increasing haemoglobin, and improving quality of life in ESA-treated anaemic cancer patients. Furthermore, i.v. iron without additional ESA should be evaluated as potential treatment in patients with chemotherapy-induced anaemia. At recommended doses, i.v. iron is well tolerated, particularly compared with oral iron. No serious drug-related adverse effects were seen during long-term use in renal disease and no effect on tumour growth has been observed in trials with anaemic cancer patients. CONCLUSIONS Reliable diagnosis and treatment of ID are recommended key steps in modern cancer patient management to minimise impact on quality of life and performance status.
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Affiliation(s)
- M Aapro
- IMO Clinique de Genolier, Genolier, Switzerland.
| | - A Österborg
- Department of Hematology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - P Gascón
- Department of Haematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - H Ludwig
- Department of Medicine I, Center for Oncology and Haematology, Wilhelminenspital, Vienna, Austria
| | - Y Beguin
- Department of Medicine, Division of Hematology, University Hospital Liège, Liège, Belgium
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Steinmetz HT. The role of intravenous iron in the treatment of anemia in cancer patients. Ther Adv Hematol 2012; 3:177-91. [PMID: 23556124 PMCID: PMC3573441 DOI: 10.1177/2040620712440071] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anemia is a major cause of morbidity in cancer patients resulting in poor physical performance, prognosis and therapy outcome. Initially, erythropoietin-stimulating agents (ESAs) were supposed to be the treatment of choice but about one third of patients turned out to be nonresponders and meta-analyses provided evidence of an increased risk of mortality if used excessively. This along with the successful use of intravenous iron for anemia in patients with chronic kidney disease prompted seven clinical studies evaluating the efficacy of intravenous iron as an adjunct to ESAs and four additional studies using intravenous iron only for anemia in cancer patients. These studies confirmed a superior response if ESAs are combined with intravenous iron and revealed iron only to be a useful option in patients with mild and absolute iron deficiency (AID). Currently, best treatment decisions for anemia in cancer might be based on measurements of serum ferritin (SF), transferrin saturation (TSAT), soluble transferrin receptor (sTfR), ferritin index (FI = sTfR/log SF), hypochromic reticulocytes (CHR) and C-reactive protein (CRP). However, there is still an urgent need for trials investigating diagnostic approaches to optimize therapy of anemia in cancer patients with iron and/or ESAs.
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Affiliation(s)
- H Tilman Steinmetz
- Outpatient Clinic for Hematology and Oncology, Sachsenring 69, 50677 Cologne, Germany
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Mario N. Marqueurs biologiques pour le diagnostic des troubles du métabolisme du fer. REVUE FRANCOPHONE DES LABORATOIRES 2012; 2012:39-48. [DOI: 10.1016/s1773-035x(12)71456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Steinmetz T, Totzke U, Schweigert M, Mittermüller J, Nawka S, Tesch H, Groschek M, Söling U, Hellebrand E, Tsamaloukas A. A prospective observational study of anaemia management in cancer patients - results from the German Cancer Anaemia Registry. Eur J Cancer Care (Engl) 2010; 20:493-502. [PMID: 21029222 DOI: 10.1111/j.1365-2354.2010.01230.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The use of erythropoiesis-stimulating agents (ESA) in cancer patients is still under debate. However, little is known about rationales, strategies, objectives, and effectiveness of anaemia treatments in common practice. The Cancer Anaemia Registry prospectively surveyed about 2000 cancer patients with anaemia throughout Germany. The main objectives of anaemia treatment regardless of modality were to improve quality of life (QOL) and to correct haemoglobin (Hb) levels. The Hb threshold for any anaemia treatment (means ± SD: 9.4 ± 1.2 g/dL) but not for blood transfusions (8.7 ± 1.0 g/dL) depended on cancer type and treatment strategy. Physicians preferred ESA as first-line treatment to prevent transfusions in patients with solid tumours, if they thought that chemotherapy caused the anaemia. If they suspected other causes or patients had lymphoproliferative malignancies, physicians preferred transfusions or attempted to correct underlying disorders; both mainly to improve QOL or prognosis. Effectiveness of all strategies was comparable. However, ESA most effectively prevented transfusions; primary transfusions appeared less suitable for correcting Hb or improving QOL. Using supportive treatments for QOL improvement was common whereas diagnostic measures and intravenous iron therapy were underused. Prospective clinical trials using QOL as end point and evaluating diagnostics in cancer-associated anaemia are warranted.
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Affiliation(s)
- T Steinmetz
- Outpatient Clinic, Sachsenring, Cologne, Germany.
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