Iron metabolism and iron supplementation in cancer patients

Ludwig, Heinz; Evstatiev, Rayko; Kornek, Gabriela; Aapro, Matti; Bauernhofer, Thomas; Buxhofer‐Ausch, Veronika; Fridrik, Michael A.; Geissler, Dietmar; Geißler, Klaus; Gisslinger, Heinz; Koller, Elisabeth; Kopetzky, Gerhard; Lang, Alois; Rumpold, Holger; Steurer, Michael; Kamali, Houman; Link, Hartmut

doi:10.1007/s00508-015-0842-3

Cited by 123 publications

(116 citation statements)

References 63 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…After reviewing the ferritin parameters used in other studies of FID we judged those with a value between 30-800ng/ml to be in keeping with FID [2,9,20,21]. Using % hypochromic red cells to detect FID has been well described [14,15,16].…”

Section: Discussionmentioning

confidence: 99%

Estimating prevalence of functional iron deficiency anaemia in advanced cancer

Neoh

Stanworth

Pasricha

et al. 2016

Support Care Cancer

View full text Add to dashboard Cite

PurposeAnaemia is a common complication of cancer causing symptoms including fatigue. It is also associated with shorter survival. Cancer causes systemic inflammation which interrupts iron metabolism leading to a functional iron deficiency (FID). There are few data on prevalence or aetiology of anaemia in those with advanced cancer. We aimed to establish the prevalence of anaemia and estimate extent of FID anaemia in patients with advanced cancer. MethodsAll patients with advanced cancer referred to two UK specialist palliative care services over one year were identified. Demographic and clinical data were linked with routinely collected haematological and biochemical profiles. We assessed the numbers of patients with abnormal values for haemoglobin, %hypochromic red cells (>5% indicates iron restricted erythropoiesis) and CRP (>10 indicates systemic inflammation). We judged that FID anaemia was likely when patients had all three abnormalities and ferritin 30-800ng/ml. Results 1797/2416 patients had a cancer diagnosis and laboratory data available. Mean haemoglobin was 116g/L. 63% of patients were anaemic; mild 25%, moderate 35% and severe 3%. Women had significantly higher mean haemoglobin than men and there was wide variation in anaemia prevalence across tumour sites. Thirty nine percent of patients' who had all four parameters checked met our criteria for FID anaemia. There were significant relationships between haemoglobin, %hypochromic red cells and CRP (p=0.0001). ConclusionsAnaemia was common in this population and we estimate this was caused by FID in 66% of anaemic patients. Further research is needed to validate our diagnostic criteria before this approach can be used in clinical practice.

show abstract

Section: Discussionmentioning

confidence: 99%

Estimating prevalence of functional iron deficiency anaemia in advanced cancer

Neoh

Stanworth

Pasricha

et al. 2016

Support Care Cancer

View full text Add to dashboard Cite

show abstract

“…There are several causes of cancer-associated malignant anemia, such as bleeding, hemolysis, lack of nutrition, bone marrow necrosis and fibrosis caused by tumor cell infiltration, direct inhibition of red blood cells caused by radiotherapy and chemotherapy, relative insufficiency of erythropoietin (EPO) secretion (3), hematopoietic inhibition and influence of iron metabolism and reduced reactivity of EPO and cytokines from cancerous human bone marrow (4)(5)(6). Malignant tumor anemia is a common complication in various malignant tumors, in which red blood cell depletion leads to inadequate tissue oxygenation, reducing the sensitivity of tumors to radiation and chemotherapy, thereby lowering the patient's quality of life, decreasing survival time and affecting overall prognosis (4,7,8).…”

Section: Introductionmentioning

confidence: 99%

“…Blood transfusions may decrease the survival rate, and tumor recurrence may occur following blood transfusion, which may lead to poor prognosis. The effect of iron supplements alone is often slow, with low efficacy (2,5). EPO is a type of high-purity active glycoprotein produced using genetically modified technology, and it specifically stimulates bone marrow hematopoietic cells (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Erythropoietin for cancer-associated malignant anemia: A meta-analysis

Zhao¹,

Wang²,

Liu³

et al. 2017

Molecular and Clinical Oncology

View full text Add to dashboard Cite

Abstract. The present study aimed to evaluate the effectiveness of erythropoietin (EPO) for improving cancer-associated malignant anemia. A search was performed for randomized clinical trials, conducted according to the Cochrane manual, using electronic databases including PubMed, EMBASE, the Cochrane Library and ClinicalTrails.gov up to 15 August 2015. A total of 6 eligible studies from 5 articles enrolling a total of 453 patients were entered into the current meta-analysis. Upon EPO treatment, there were significant differences in the change in hemoglobin (HB) levels compared with the placebo at short-term follow-up [mean difference (MD)=0.66; 95% confidence interval (CI), 0.14-1.18; I 2 =Not applicable; P=0.01) and long-term follow-up (MD=0.10; 95% CI, 0.02-0.18; I 2 =Not applicable; P=0.01) under the random effects model. For changes in hematocrit (HCT) compared with the placebo, the results revealed there were significant differences at short-term follow-up (MD=2.47; 95% CI, 0.75-4.19; I 2 =Not applicable; P=0.005) and long-term follow-up (MD=7.60; 95% CI, 6.15-9.05; I 2 =Not applicable; P<0.00001) under the random effects model. Compared with the placebo in short-term follow-up under the fixed effects model with homogeneity, the result was a significant difference for the transfusion ratio [relative risk (RR)=0.81; 95% CI, 0.67-0.97; I 2 =34%; P=0.02) and the transfusion requirements (MD=-0.45; 95% CI, -0.92, 0.03; I 2 =6%; P=0.07). Funnel plots did not detect any publication bias. These results suggest that EPO was beneficial to alleviate cancer-associated anemia and improve survival outcomes for patients with cancer.

show abstract

“…The cytokine interleukin-6, which stimulates the production of the protein hepcidin in the liver, deserves special mentioning here. Hepcidin in turn inhibits the uptake of iron (also from iron tablets) from the duodenum and the release of iron from the stores of the reticuloendothelial system (RES) [25]. As a result, erythropoiesis has too little iron available, resulting in functional iron deficiency and anemia.…”

Section: Management Of Anemia With Erythropoiesis-stimulating Factorsmentioning

confidence: 99%

Hematopoietic Growth Factors in the Management of Anemia and Febrile Neutropenia

Link

2019

Breast Care

Self Cite

View full text Add to dashboard Cite

Chemotherapy-induced anemia (CIA) in cancer patients correlates with poor performance status and decreased quality of life. Currently recommended causal therapies are erythropoiesis-stimulating agents (epoetins), iron substitution, or a combination of both. Guidelines recommend considering red blood cell (RBC) transfusions for symptomatic anemia at a hemoglobin (Hb) level of <8 g/dl. Granulocyte colony-stimulating factor (G-CSF) is recommended if the risk of febrile neutropenia (FN) following from the chosen chemotherapy protocol is ≥20%. If a chemotherapy is planned that induces a moderate FN risk (10-20%), the individual overall FN risk should be assessed prior to each chemotherapy cycle, taking into account patient- or tumor-related risk factors. G-CSF is required when risk factors such as age ≥ 65 years, advanced disease or relevant comorbidity, or previous neutropenia complications are present. Neutropenia that required a shift in chemotherapy is also an indication for G-CSF prophylaxis in subsequent cycles, in order to maintain the planned dose intensity. The use of G-CSF improves patient survival and reduces the rate of neutropenia complications.

show abstract

Iron metabolism and iron supplementation in cancer patients

Cited by 123 publications

References 63 publications

Estimating prevalence of functional iron deficiency anaemia in advanced cancer

Estimating prevalence of functional iron deficiency anaemia in advanced cancer

Erythropoietin for cancer-associated malignant anemia: A meta-analysis

Hematopoietic Growth Factors in the Management of Anemia and Febrile Neutropenia

Contact Info

Product

Resources

About