A new concept for the differential diagnosis and therapy of anaemia in cancer patients.
OBJECTIVE
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.
Oncology Outpatient Clinic in Cologne, Cologne, Germany. steinmetz@oncokoeln.de
H Tilman
HT
Steinmetz
Antonis
A
Tsamaloukas
Stephan
S
Schmitz
Jörg
J
Wiegand
Robert
R
Rohrberg
Jochen
J
Eggert
Friedhelm
F
Breuer
Hans-Werner
HW
Tessen
Heidi
H
Eustermann
Lothar
L
Thomas
D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D005293:Ferritins / Q000097:blood / Q000172:deficiency; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000172:deficiency / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000097:blood; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012156:Reticulocytes / Q000378:metabolism
D000970:Antineoplastic Agents; D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D005293:Ferritins; D007501:Iron