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A new concept for the differential diagnosis and therapy of anaemia in cancer patients

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Abstract

Purpose

This study aimed to prove the usefulness of the diagnostic plot, using the haemoglobin content of reticulocytes as a measure of functional iron deficiency (FID) and the ferritin index as a measure of iron availability, to customise anaemia treatment in cancer patients.

Methods

Based on results of this plot, cancer patients fulfilling practice guideline criteria to receive erythropoiesis-stimulating agents (ESAs) were allocated to treatment with ESAs alone, iron alone or the combination of both. Primary endpoint was the percentage of patients identified to require iron in addition or as an alternative to ESA therapy.

Results

Out of 303 patients screened, 286 were allocated to treatment: 204 patients were normochromic and iron replete and treated with ESAs alone, 22 had both FID and anaemia of chronic disease and were treated with ESAs and parenteral iron, and 60 were iron-depleted and treated with iron only. After 8 weeks, a haemoglobin increase >1 g/dL from baseline was shown by 56% of patients treated with ESAs alone, by 100% of patients receiving the combination, by 50% of normochromic and by 73% of hypochromic iron-depleted patients receiving iron only. Acute phase reaction did not diminish the response rate to ESAs.

Conclusions

The diagnostic plot was superior to transferrin saturation and ferritin in predicting iron availability in hypochromic patients treated with ESAs and proved useful to select treatment for anaemia in cancer patients.

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Acknowledgements

The study was supported by Roche-Pharma AG, Grenzach-Wyhlen, Germany. The authors would like to thank Uwe Totzke (Totzke Scientific, Geneva, Switzerland) for revising the manuscript.

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Authors and Affiliations

  1. Oncology Outpatient Clinic in Cologne, Cologne, Germany

    H. Tilman Steinmetz & Stephan Schmitz

  2. Oncology Outpatient Clinic in Hilden, Hilden, Germany

    Antonis Tsamaloukas

  3. Oncology Outpatient Clinic in Moers, Moers, Germany

    Jörg Wiegand & Jochen Eggert

  4. Oncology Outpatient Clinic in Halle/Saale, Halle/Saale, Germany

    Robert Rohrberg

  5. Oncology Outpatient Clinic in Frechen, Frechen, Germany

    Friedhelm Breuer

  6. Oncology Outpatient Clinic in Goslar, Goslar, Germany

    Hans-Werner Tessen

  7. Wissenschaftlicher Service Pharma (WISP), Langenfeld, Germany

    Heidi Eustermann

  8. Krankenhaus Nordwest, Central Laboratory, Frankfurt/Main, Germany

    Lothar Thomas

  9. Praxis für Hämatologie und Onkologie, Sachsenring 69, 50677, Cologne, Germany

    H. Tilman Steinmetz

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  1. H. Tilman Steinmetz
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Correspondence to H. Tilman Steinmetz.

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Steinmetz, H.T., Tsamaloukas, A., Schmitz, S. et al. A new concept for the differential diagnosis and therapy of anaemia in cancer patients. Support Care Cancer 19, 261–269 (2011). https://doi.org/10.1007/s00520-010-0812-2

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  • DOI: https://doi.org/10.1007/s00520-010-0812-2

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