Oncology Outpatient Clinic in Cologne, Cologne, Germany.
Support Care Cancer. 2010 Feb;19(2):261-9. doi: 10.1007/s00520-010-0812-2. Epub 2010 Feb 11.
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.
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.
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.
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.
本研究旨在通过使用网织红细胞血红蛋白含量作为功能性铁缺乏（FID）的衡量指标，以及铁蛋白指数作为铁可用性的衡量指标，证明诊断图在定制癌症患者贫血治疗方面的有用性。
基于该诊断图的结果，符合接受促红细胞生成素刺激剂（ESA）治疗指南标准的癌症患者被分配接受ESA 单独治疗、铁剂单独治疗或两者联合治疗。主要终点是确定需要额外铁剂或替代 ESA 治疗的患者比例。
在 303 名筛选患者中，286 名被分配接受治疗：204 名患者为正色素和铁充足，接受 ESA 单独治疗；22 名患者同时存在 FID 和慢性疾病性贫血，接受 ESA 和静脉铁剂治疗；60 名患者铁缺乏，接受铁剂单独治疗。8 周后，ESA 单独治疗组有 56%的患者血红蛋白较基线水平升高≥1g/dL，联合治疗组为 100%，正色素铁充足患者为 50%，铁缺乏的低色素患者为 73%。急性期反应并未降低 ESA 的反应率。
与转铁蛋白饱和度和铁蛋白相比，诊断图在预测接受 ESA 治疗的低色素患者的铁可用性方面更具优势，并证明有助于选择癌症患者贫血的治疗方法。
