The addition of oral iron improves chemotherapy-induced anemia in patients receiving erythropoiesis-stimulating agents
Jingyong Tan
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Search for more papers by this authorSitong Du
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Search for more papers by this authorXueyan Zang
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Xiangya School of Medicine, Central South University, Changsha, China
Search for more papers by this authorKaiyue Ding
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Xiangya School of Medicine, Central South University, Changsha, China
Search for more papers by this authorYelena Ginzburg
Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Search for more papers by this authorCorresponding Author
Huiyong Chen
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Correspondence
Huiyong Chen, Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha 410078, China.
Email: [email protected]
Search for more papers by this authorJingyong Tan
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Search for more papers by this authorSitong Du
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Search for more papers by this authorXueyan Zang
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Xiangya School of Medicine, Central South University, Changsha, China
Search for more papers by this authorKaiyue Ding
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Xiangya School of Medicine, Central South University, Changsha, China
Search for more papers by this authorYelena Ginzburg
Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Search for more papers by this authorCorresponding Author
Huiyong Chen
Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
Correspondence
Huiyong Chen, Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha 410078, China.
Email: [email protected]
Search for more papers by this authorFunding information: Changsha Municipal Nature Science Foundation, Grant/Award Number: kq2014139; Key Research and Development Program of Hunan Province of China, Grant/Award Number: 2022SK2037; Natural Science Foundation of Hunan Province, Grant/Award Number: 2021JJ30892
Abstract
Although many studies have shown that supplementation with iron and erythropoiesis-stimulating agents (ESA) is frequently used for managing chemotherapy-induced anemia (CIA), optimal combination therapy using these agents together to ameliorate anemia is not well characterized. To assess the effects of ESA combined with oral or intravenous (IV) iron on relieving CIA, PubMed, Cochrane Library, Embase and China National Knowledge Infrastructure (CNKI) were searched for articles. Data collected in the articles were meta-analyzed using RevMan 5.3 software with a random-effects model. Our comprehensive search yielded 1666 potentially relevant trials. A total of 41 trials randomizing 4200 patients with CIA fulfilled inclusion criteria, including 34 Chinese articles and 7 English articles. Meta-analysis showed that treatment with both ESA and iron more effectively improved CIA relative to iron supplementation alone, with increased hemoglobin, hematocrit, red blood cell count and hematopoietic response rate. Subgroup analyses revealed iron administration, both oral and IV iron, improved anemia in ESA-treated cancer patients with CIA. Our analysis demonstrates that iron supplementation combined with ESA more effectively ameliorates CIA relative to iron supplementation alone, without regard to whether IV or oral iron was used. Together, our findings may contribute to the clinical treatment of CIA using iron therapy with or without ESA.
Graphical Abstract
What's new?
Chemotherapy-induced anemia is a common event among cancer patients, and it is generally treated with oral or intravenous iron supplementation as well as erythropoiesis-stimulating agents. Here, the authors analyzed the literature, both in English and Chinese, to assess the effectiveness of these treatments. They identified 41 trials, involving 4200 patients, and showed that treatment with both ESA and iron more effectively improved anemia compared to iron supplementation alone. This is the first analysis that incorporates the Chinese literature on this subject, substantially increasing the number of trials available.
CONFLICT OF INTEREST
The authors declare that they have no competing interests.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of our study are available from the corresponding author upon request.
Supporting Information
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| ijc34142-sup-0001-Supinfo.pdfPDF document, 1.8 MB | Appendix S1 Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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