title: Intravenous iron monotherapy for the treatment of non-iron-deficiency anemia in cancer patients undergoing chemotherapy: a pilot study.
abstract: BACKGROUND
  Anemia in patients with cancer who are undergoing active therapy is commonly encountered and may worsen quality of life in these patients. The effect of blood transfusion is often temporary and may be associated with serious adverse events. Erythropoiesis-stimulating agents are not effective in 30%-50% of patients and may have a negative effect on overall survival.
  
  
  OBJECTIVE
  To assess the efficacy and feasibility of intravenous iron therapy in patients with cancer who have non-iron-deficiency anemia and who are undergoing treatment with chemotherapy without the use of erythropoiesis-stimulating agents.
  
  
  METHODS
  Adult patients with solid cancers and non-iron-deficiency anemia were included. Ferric sucrose at a dose of 200 mg was given in short intravenous infusions weekly for a total of 12 weeks. Hemoglobin level was measured at baseline, every 3 weeks, and 2 weeks after the last iron infusion (week 14). Adverse events related to intravenous iron were prospectively reported.
  
  
  RESULTS
  Of 25 patients included, 19 (76.0%) completed at least three iron infusions and 14 (56.0%) finished the planned 12 weeks of therapy. The mean hemoglobin level of the 25 patients at baseline was 9.6 g/dL (median, 9.9 g/dL; range, 6.9 g/dL 10.9 g/dL). The mean change in hemoglobin level for the 15 patients who completed at least 9 treatments was 1.7 g/dL (median, 1.1 g/dL; range, -1.9 g/dL to 3.2 g/dL); it reached 2.1 g/dL (median, 1.3 g/dL; range, -0.2 g/dL to 4.6 g/dL; P = 0.0007) for the 14 patients who completed all 12 weekly treatments. Five (20.0%) patients were transfused and considered as treatment failures. No treatment-related adverse events were reported.
  
  
  CONCLUSIONS
  Intravenous iron treatment alone is safe and may reduce blood transfusion requirements and improve hemoglobin level in patients with cancer who are undergoing anticancer therapy. Further randomized studies are needed to confirm these findings.
authors.affiliation: Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan. habdelrazeq@khcc.jo
authors.forename: Hikmat
authors.initials: H
authors.lastname: Abdel-Razeq
authors.forename: Salah
authors.initials: S
authors.lastname: Abbasi
authors.forename: Iyad
authors.initials: I
authors.lastname: Saadi
authors.forename: Rana
authors.initials: R
authors.lastname: Jaber
authors.forename: Hazem
authors.initials: H
authors.lastname: Abdelelah
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077605:Ferric Oxide, Saccharated; D005500:Follow-Up Studies; D005937:Glucaric Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006397:Hematinics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005290:Ferric Compounds; D006397:Hematinics; D006454:Hemoglobins; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid
keywords: anemia; cancer; chemotherapy; intravenous iron; transfusion
references.citation: Am J Kidney Dis. 2003 Jun;41(5 Suppl):18-26
references.pmid: 12776310
references.citation: Curr Oncol Rep. 2004 Jul;6(4):297-304
references.pmid: 15161584
references.citation: Am J Kidney Dis. 1995 Jul;26(1):41-6
references.pmid: 7611266
references.citation: J Clin Oncol. 1997 Mar;15(3):1218-34
references.pmid: 9060566
references.citation: Am J Med. 2004 Apr 5;116 Suppl 7A:11S-26S
references.pmid: 15050883
references.citation: J Clin Invest. 2004 May;113(9):1251-3
references.pmid: 15124013
references.citation: J Am Soc Nephrol. 2005 Oct;16(10):3070-80
references.pmid: 16033854
references.citation: J Clin Oncol. 2008 Apr 1;26(10):1611-8
references.pmid: 18375890
references.citation: Gynecol Obstet Invest. 2003;56(1):28-34
references.pmid: 12867765
references.citation: Lancet. 2003 Oct 18;362(9392):1255-60
references.pmid: 14575968
references.citation: Blood. 1997 Jun 15;89(12):4248-67
references.pmid: 9192747
references.citation: N Engl J Med. 2005 Mar 10;352(10):1011-23
references.pmid: 15758012
references.citation: J Clin Oncol. 2008 Apr 1;26(10):1619-25
references.pmid: 18375891
references.citation: Lancet Oncol. 2003 Aug;4(8):459-60
references.pmid: 12901958
references.citation: J Am Soc Nephrol. 1999 Sep;10(9):2029-43
references.pmid: 10477157
references.citation: J Natl Cancer Inst. 2005 Apr 6;97(7):489-98
references.pmid: 15812074
references.citation: Ann Oncol. 2004 Jun;15(6):979-86
references.pmid: 15151958
references.citation: J Clin Oncol. 1998 Oct;16(10):3412-25
references.pmid: 9779721
references.citation: Gastroenterology. 2004 Nov;127(5 Suppl 1):S79-86
references.pmid: 15508107
references.citation: Kidney Int Suppl. 1999 Mar;69:S61-6
references.pmid: 10084288
references.citation: Oncologist. 2007 Feb;12(2):231-42
references.pmid: 17296819
references.citation: Cancer. 2003 Oct 1;98(7):1514-20
references.pmid: 14508840
references.citation: Leukemia. 2007 Apr;21(4):627-32
references.pmid: 17252006
references.citation: Oncologist. 1998;3(4):275-278
references.pmid: 10388116
references.citation: Am J Hematol. 2010 Sep;85(9):655-63
references.pmid: 20661916
references.citation: J Clin Oncol. 2001 Jun 1;19(11):2865-74
references.pmid: 11387359
references.citation: Oncologist. 2002;7(6):492-508
references.pmid: 12490737
references.citation: Ann Oncol. 2013 Feb;24(2):475-482
references.pmid: 23071262
references.citation: Am J Kidney Dis. 2007 Sep;50(3):471-530
references.pmid: 17720528
references.citation: J Investig Med. 1998 Apr;46(4):161-7
references.pmid: 9635376
references.citation: J Clin Oncol. 2001 Jun 1;19(11):2875-82
references.pmid: 11387360