Division of Hematology and Hematologic Malignancies, University of Utah Health Sciences Center, Salt Lake City, Utah, USA,
Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
Acta Haematol. 2019;142(1):13-20. doi: 10.1159/000496967. Epub 2019 Apr 10.
Cancer-related anemia (CRA) is a commonly occurring problem for patients with cancer regardless of whether they are receiving treatment with chemotherapy or immunotherapy. It may result from one or more processes (decreased production, increased destruction, or increased loss of red blood cells, RBC). Perturbations in iron availability form the primary basis for anemia in many patients with cancer-related anemia. Functional iron deficiency (FID) anemia is a condition in which the patient has adequate or increased iron stores, but this iron pool is not available for erythropoiesis. Erythropoiesis-stimulating agents (ESAs) were the original treatment for FID; over time, however, if the supply of iron cannot keep pace with increased RBC synthesis driven by ESAs, FID may eventually lead to the lack or loss of ESA responsiveness. Subsequent clinical trials reported that intravenous (IV) iron could enhance the erythropoietic response to ESAs. This chapter reviews the pathogenesis of FID and summarizes the literature on the treatment of cancer- and chemotherapy-induced anemia. Clinical trials using IV iron with or without ESAs are reviewed in addition to the currently available IV iron products. The consensus conclusions from these trials, as well as guideline recommendations, support the use of IV iron in these patients to enhance ESA responsiveness, decrease ESA dosage, and reduce RBC transfusions. Little data have been published on the long-term safety of IV iron or its impact on tumor growth. This paper also briefly explores novel approaches for the treatment of FID anemia, which has relevance in treating not only cancer patients but also patients with benign inflammatory disorders.
癌症相关性贫血(CRA)是癌症患者中常见的问题,无论他们是否正在接受化疗或免疫治疗。它可能是由一个或多个过程(红细胞生成减少、破坏增加或丢失增加)引起的。铁供应的紊乱是许多癌症相关性贫血患者贫血的主要基础。功能性缺铁性贫血(FID)是一种患者铁储存充足或增加,但这种铁池不能用于红细胞生成的情况。红细胞生成刺激剂(ESA)是治疗 FID 的最初方法;然而,随着时间的推移,如果铁的供应不能跟上 ESA 驱动的红细胞合成增加的速度,FID 最终可能导致 ESA 反应性缺乏或丧失。随后的临床试验报告称,静脉内(IV)铁可以增强 ESA 对红细胞生成的反应。本章回顾了 FID 的发病机制,并总结了关于癌症和化疗引起的贫血的治疗文献。除了目前可用的 IV 铁产品外,还审查了使用 IV 铁与或不与 ESA 的临床试验。这些试验的共识结论以及指南建议支持在这些患者中使用 IV 铁以增强 ESA 反应性、减少 ESA 剂量和减少红细胞输注。关于 IV 铁的长期安全性或其对肿瘤生长的影响的数据很少。本文还简要探讨了治疗 FID 贫血的新方法,这对于治疗不仅癌症患者而且良性炎症性疾病患者都具有相关性。
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