Chemotherapy-induced anemia at an urban academic medical center: Iron studies and supplementation

Objectives: To determine the number of patients with chemotherapy-induced anemia receiving an erythropoiesis-stimulating agent (ESA) in whom iron studies were completed and iron supplementation was provided and to document the response rate of ESA therapy without parenteral iron at our medical center. Design: Retrospective chart review. Setting: Urban (Chicago) academic medical center between January 2004 and December 2005. Patients: Ambulatory patients with a nonmyeloid malignancy receiving chemotherapy during a 2-year period in whom hemoglobin (Hb) was less than 11 grams/dL or ESA therapy was documented. Intervention: Review of medical records. Main outcome measures: Number of patients reaching target Hb, time to reach target Hb, number of patients receiving a transfusion, number of patients with iron studies, and number of patients receiving iron supplementation. Results: A total of 174 medical records were reviewed, and 50 patients met study criteria. Of these, 38 patients were treated with darbepoetin alfa, 11 patients were treated with epoetin alfa, and 1 patient was not treated with either agent. 20 patients achieved the target Hb level of 12 grams/dL within a median of 7 weeks ( range 1-24 weeks). Only five patients treated with an ESA received iron supplementation, one responder and four nonresponders. Iron indices were measured in 20 patients (40%); 14 patients were candidates for iron therapy based on transferrin saturation, and 3 of these 14 patients received oral iron supplementation. Six responders and six nonresponders received a transfusion (25%). Conclusion: The overall response rate and time to Hb response were consistent with previous reports. Iron indices were not commonly measured before ESA therapy was started, and only a few patients were provided oral iron supplementation at our medical center.