Anemia during adjuvant non-taxane chemotherapy for early breast cancer: Incidence and risk factors from two trials of the International Breast Cancer Study Group.
GOAL OF THE WORK: Anemia is a common side effect of chemotherapy. Limited information exists about its incidence and risk factors. The objective of this study was to evaluate the incidence of anemia and risk factors for anemia occurrence in patients with early breast cancer who received adjuvant chemotherapy.


METHODS
We evaluated risk factors for anemia in pre- and post/perimenopausal patients with lymph node-positive early breast cancer treated with adjuvant chemotherapy in two randomized trials. All patients received four cycles of doxorubicin and cyclophosphamide (AC) followed by three cycles of cyclophosphamide, methotrexate, fluorouracil (CMF). Anemia incidence was related to baseline risk factors. Multivariable analysis used logistic and Cox regression.


RESULTS
Among the 2,215 available patients, anemia was recorded in 11% during adjuvant chemotherapy. Grade 2 and 3 anemia occurred in 4 and 1% of patients, respectively. Pretreatment hemoglobin and white blood cells (WBC) were significant predictors of anemia. Adjusted odds ratios (logistic regression) comparing highest versus lowest quartiles were 0.18 (P < 0.0001) for hemoglobin and 0.52 (P = 0.0045) for WBC. Age, surgery type, platelets, body mass index, and length of time from surgery to chemotherapy were not significant predictors. Cox regression results looking at time to anemia were similar.


CONCLUSIONS
Moderate or severe anemia is rare among patients treated with AC followed by CMF. Low baseline hemoglobin and WBC are associated with a higher risk of anemia.
Gianni
Lorenzo
L
Divisione di Oncologia e di Ematologia, Ospedale degli Infermi, and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Azienda USL-Rimini Via Settembrini 2, Rimini, Italy. lgianni@auslrn.net
Cole
Bernard F
BF
Panzini
Ilaria
I
Snyder
Raymond
R
Holmberg
Stig B
SB
Byrne
Michael
M
Crivellari
Diana
D
Colleoni
Marco
M
Aebi
Stefan
S
Simoncini
Edda
E
Pagani
Olivia
O
Castiglione-Gertsch
Monica
M
Price
Karen N
KN
Goldhirsch
Aron
A
Coates
Alan S
AS
Ravaioli
Alberto
A
D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000139:chemically induced* / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007962:Leukocytes / Q000378:metabolism; D008207:Lymphatic Metastasis; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D006454:Hemoglobins; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate