Diagnosis, treatment, and use of intravenous iron for chemotherapy-induced anemia in Europe.

Patient and Survivor Care
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This abstract will not be presented at the 2011 ASCO Annual Meeting but has been published in conjunction with the meeting.
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J Clin Oncol 29: 2011 (suppl; abstr e19557)
M. S. Aapro, Y. Beguin, C. Bokemeyer, J. A. Glaspy, M. Hedenus, T. J. Littlewood, H. Ludwig, A. Osterborg, B. Rzychon, D. Mitchell; Clinique De Genolier, Genolier, Switzerland; University Hospital Liege, Liege, Belgium; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Sundsvall Hospital, Sundsvall, Sweden; John Radcliffe Hospital, Oxford, United Kingdom; Wilhelminenspital der Stadt Wien, Vienna, Austria; Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden; Vifor Pharma, Glattbrugg, Switzerland

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Abstract Disclosures


Background: Chemotherapy-induced anemia (CIA) is a frequent complication in cancer patients. Intravenous (I.V.) iron in conjunction with an erythropoiesis-stimulating agent (ESA) is a well tolerated and effective therapy. This study evaluated current practice in diagnosis and treatment of CIA in nine European countries. Methods: Onco-hematologists completed records on their last five patients treated for CIA within six months prior to the survey. Data were collected from Jun-Oct 2009 (France, Germany, Spain, Switzerland, UK) and Aug-Nov 2010 (Austria, Italy, Netherlands, Sweden). Results are presented as median [range] between countries. Results: 1,730 cases were recorded by 375 physicians (321 hospital and 54 office-based). Lymphoma, myeloma, breast and lung cancer accounted for 60% [50-66%] of cases; 52% [30-60%] had metastatic disease. Blood tests at diagnosis of anemia included hemoglobin (Hb, 96% [86-99%]), ferritin (49% [23-60%]) and transferrin saturation (TSAT, 12% [2-25%]). Median Hb before treatment was comparable between countries (9.1 g/dL [9.0-9.6 g/dL]), but ferritin (127 µg/L [50-243 µg/L]) and TSAT (26% [15-35%]) varied more. At diagnosis, 75% [65-89%] had an Hb <10 g/dL and 14% [8-25%] an Hb <8g/dL, 44% [21-65%] had a ferritin <100 µg/L and 20% [8-41%] had a ferritin <30 µg/L. 73% [15-100%] of CIA patients were treated with an ESA and iron was given to 22% [11-61%]. Although iron was mainly given in combination with an ESA (57% [17–100%]), I.V. iron was used in only 19% [4-77%] of iron-treated patients. Notably, Switzerland was the sole country where more patients received I.V. than oral iron. A blood transfusion was given to 52% [11-93%] of patients at some stage of treatment. Conclusions: Iron status assessment and treatment of CIA vary in manner and frequency between European countries. Ferritin and TSAT, markers of absolute and functional iron deficiency (AID, FID) are underused. Only a small fraction of cancer patients with CIA receives I.V. iron therapy despite clinical evidence on the efficacy of I.V. iron compared to oral iron in supplementing ESA-based anemia treatment. Awareness of evidence on the role of I.V. iron to resolve ID and prevent FID in CIA patients needs to be broadened.