Boston Medical Center, Boston, MA 02118, USA.
Am J Health Syst Pharm. 2011 May 15;68(10 Suppl 1):S4-14; quiz S15-6. doi: 10.2146/ajhp110039.
The incidence, etiology, and management of cancer-related anemia is reviewed and the role of i.v. iron therapy in its treatment is described.
Between 30% and 90% of patients with cancer develop anemia due to direct effects of the disease, its treatment, underlying nutritional deficiencies, and the inflammation that characterizes chronic disease. Although the use of erythropoiesis-stimulating agents (ESAs) increases hemoglobin levels and decreases the need for transfusions, up to 50% of patients do not to respond to these drugs, usually due to the presence of absolute or functional iron deficiency. Multiple clinical trials have demonstrated that i.v. iron supplementation in patients with cancer-related anemia improves the response rate to ESAs, reduces the time to target hemoglobin levels, decreases ESA requirements, reduces costs, and is more efficacious than oral iron. These benefits are seen without increased toxicity. Nonetheless, i.v. iron remains underused in patients with cancer, partly due to misinformation and misinterpretation of the clinical nature of adverse events.
Intravenous iron is underutilized in patients with cancer-related anemia. Based on published evidence, i.v. iron supplementation in patients with absolute or functional iron deficiency can improve patient responses to ESAs and reduce ESA requirements and may also reduce the need for transfusions and improve quality of life.
本文回顾了癌症相关性贫血的发病情况、病因和处理方法，并描述了静脉铁治疗在其中的作用。
30%至 90%的癌症患者会因疾病本身、治疗、潜在营养缺乏以及慢性疾病的炎症等直接作用而发生贫血。虽然促红细胞生成素刺激剂（ESA）的使用可以提高血红蛋白水平并减少输血需求，但多达 50%的患者对这些药物没有反应，通常是由于绝对或功能性缺铁所致。多项临床试验表明，癌症相关性贫血患者静脉补铁可提高 ESA 反应率，缩短达到目标血红蛋白水平的时间，减少 ESA 需求，降低成本，并且比口服铁剂更有效。而且，静脉补铁并不会增加毒性。尽管如此，癌症患者对静脉铁的使用仍不足，部分原因是对不良反应的临床性质存在误解和错误解读。
癌症相关性贫血患者对静脉铁的使用不足。基于已发表的证据，绝对或功能性缺铁的癌症患者静脉补铁可改善患者对 ESA 的反应，并减少 ESA 的需求，还可能减少输血需求并提高生活质量。
