Parenteral iron with erythropoiesis-stimulating agents for chemotherapy-induced anemia.
OBJECTIVE
To discuss the clinical issues we addressed in the development of our institutional guidelines regarding the assessment of iron stores for cancer- and treatment-related anemia and the administration of parenteral iron with erythropoiesis-stimulating agents (ESAs).


METHODS
Studies published from January 1995 to August 2007 were identified by computer searches of Medline and hand searching of bibliographies of the articles identified via the computer searches. The current clinical practice guidelines were identified by computer searches of the web sites for national professional organizations that represent health care professionals who treat patients with cancer.


RESULTS
of data analysis. Hematopoietic responses demonstrate that epoetin alfa and darbepoetin alfa provide similar outcomes for patients with chemotherapy-induced anemia (CIA); however, up to 50% of patients receiving these agents fail to adequately respond. Functional iron deficiency defined as a state of iron-restricted erythropoiesis is likely the primary contributor to the lack of response. Hematopoietic responses following ESA therapy with parenteral iron are substantially higher compared to response with no or oral iron.


CONCLUSIONS
Iron stores should be assessed in all patients with cancer- or treatment-related anemia and parenteral iron should be administered to patients receiving ESA therapy to improve hematopoietic response. A unique algorithm that summarizes our institutional guidelines to assess iron stores and administer parenteral iron with ESA therapy in patients with CIA is included.
Shord
Stacy S
SS
University of Illinois College of Pharmacy, Chicago, Illinois 60612, USA. sshord@uic.edu
Hamilton
J M
JM
Cuellar
Sandra
S
D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects; D000068256:Darbepoetin alfa; D004359:Drug Therapy, Combination; D000068817:Epoetin Alfa; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D058085:Iron Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins
D000970:Antineoplastic Agents; D006397:Hematinics; D058085:Iron Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa