12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
significant difference was found at RET vs Diagnosis in Non Responders.
IL4 was significantly lower at RET (1324) vs Diagnosis (4748) (p
0.003) in Non Responders but not in Responders. Conclusions. 1.TNF-α
and IFN-γ were confirmed to be over-expressed in marrow of both AD
and NAD AAA patients. 2. TNF-α and IFN-γ decline more in patients
Responding vs Non responding to IS. 3. Myelosuppressive cytokines
remain in the marrow also of patients who respond to IS. This smouldering
activity may contribute to relapse in case of immune attack reactivation.
4. The reduced expression of IL-4 in may contribute to the
disease by not counterbalancing the Th1 polarization in Non Responding
patients. Overall these data indicate TNF-α and IFN-γ as crucial
effectors of marrow damage in AAA and suggest to strengthen IS with
targeted anti cytokine treatments that may reduce the risk of relapse
after IS.
0077
HIGH PREVALENCE OF ANAEMIA AMONG FRENCH HOSPITALIZED CANCER PATIENTS:
A ONE-DAY CROSS-SECTIONAL SURVEY
S. Castaigne, 1 J.M. Tourani, 2 S. Delaloge, 3 C. Hennequin, 4 M. Zureik, 5
E. Lemarié6 1 Hôpital de Versailles, LE CHESNAY; 2 Hôpital La Miletrie, POITIERS; 3 Institut
Gustave Roussy, VILLEJUIF; 4 Hôpital Saint Louis, PARIS; 5 INSERM U700,
PARIS; 6 Hôpital Bretonneau, TOURS, France
Objective. To evaluate the prevalence of anaemia (haemoglobin [Hb]
24 hours. 76.9% of patients received cancer treatment
(recurrent disease: 44.2%); 42.7% of patients had a performance status
of ?2. 23.8% of patients had haematological malignancies (including
lymphoma, 8.9%; and acute leukaemia, 6.3%) and 76.2% had solid
tumours (including lung cancer 15.9%; colorectal cancer 14.4%; and
breast cancer 12.8%). 57.6% of solid tumours were metastatic. Hb levels
ranged from a minimum of 4.2 to a maximum of 18.9 g/dL
(11.2±1.9). 63.8% of patients had anaemia (77.3% among patients with
haematological tumours; 59.5% in patients with solid tumours). 57.8%
of anaemia cases were considered to be related to cancer treatment.
59.1% of patients receiving CT were anaemic. 47.4% of anaemic
patients were not being treated for their anaemia. Among patients
receiving 1 or more treatment for anaemia, the treatments included
transfusion (28.5%), erythropoietin stimulating protein (27.0%), and
nutritional supplements (iron and/or vitamins) (19.1%). Further analysis
of patients not treated for anaemia is underway. Conclusions. These
results confirm the findings of ECAS, a large European survey of
anaemia in cancer patients. Better identification of the causes of
anaemia in cancer patients may optimize patient care. Detailed data on
haematological patients will be presented.
0078
INTRAVENOUS IRON IMPROVES RESPONSE RATES TO RECOMBINANT HUMAN ERY-
THROPOIETIN IN ANAEMIC PATIENTS WITH HAEMATOLOGICAL MALIGNANCY ON
CHEMOTHERAPY WHICH IRON PARAMETERS TO USE?
P. Greaves, 1 S. Agrawal, 1 C. Lim, 1 C. Poole2 1 2 St Bartholomew's Hospital, LONDON; Threesixtydegree Research Ltd,
CARDIFF, United Kingdom
Background. Recombinant human erythropoietin (rhEpo) may be used
to avoid transfusion and improve quality of life in the anaemia of cancer.
Poor response rates to rhEpo are a factor contributing towards its
poor uptake in clinical practice. Supplementation with intravenous iron
improves response rates to rhEpo. Biochemical markers of iron status
may guide rational use of iron supplementation, but they are often unreliable,
being altered by the same factors that disrupt iron metabolism and
contribute to the anaemia of malignancy. Functional iron deficiency
(FID) is a status whereby iron stores are adequate by biochemical param-
28 | haematologica/the hematology journal | 2007; 92(s1)
eters but rendered inaccessible to erythropoiesis, perhaps through
cytokine dysregulation. Aims. ASH/ASCO-based guidelines and a protocol-based
approach to the use of intravenous iron and rhEpo in the
treatment of non-myeloid haematological malignancy have been used
in our centre for the last 4 years. Monitoring of several biochemical iron
status markers was integral to the protocol. The aim was to determine
which iron parameters most consistently predicted FID and hence the
need for intravenous iron. Methods. A prospective audit was carried out
of patients with non-myeloid haematological malignancy on chemotherapy
and who were anaemic and receiving rhEpo. Intravenous iron supplementation
was based on the following iron parameters: haemoglobin,
mean corpuscular haemoglobin, serum ferritin, transferrin saturation,
zinc protoporphyrin (ZPP), reticulocyte count and reticulocyte
haemoglobin concentration (CHr). Measurements were made at baseline,
weeks 4 and 8, then as indicated by a suboptimal haemoglobin
(Hb) response. The data were examined to determine which measures
most frequently triggered the addition of intravenous iron at baseline
(indicating FID) and which measures most frequently indicated the
development of FID during rhEpo therapy, leading to later addition of
intravenous iron. Results. The iron status indices of 54 patients receiving
rhEpo were analysed. 68% had myeloma, 17% CLL, 6% Waldenstrom’s
macroglobulinemia and 9% other non-Hodgkin’s lymphoma. Their
mean baseline haemoglobin was 9.2 g/dL. 50% of patients received
intravenous iron. Abnormal baseline ZPP was most frequently the irondeficiency
trigger for commencing intravenous iron supplementation
on first instigating rhEpo therapy. In patients started on rhEpo alone, the
development of functional iron-deficiency during rhEpo-driven erythropoiesis
was best monitored by changes in transferrin saturation and
serum ferritin, leading to commencement of intravenous iron. However,
in some patients, intravenous iron was instituted in spite of biochemical
parameters not themselves indicating iron deficiency, because of
downward trends in transferrin saturation and serum ferritin. Intravenous
iron commencement enabled rhEpo maintenance doses to be
reduced and even discontinued. With this approach, the overall response
rate was 90% (81% > 2g/dL Hb increase) and mean Hb increment was
3.25 g/dL. Summary and Conclusions. Rational use of intravenous iron to
support rhEpo therapy in haematological malignancy is possible with
readily available, inexpensive biochemical parameters of iron status.
ZPP most frequently reflects initial iron depletion, while transferrin saturation
and serum ferritin trends best reflect development of functional
iron deficiency during rhEpo therapy.
0079
SEQUENTIAL MONITORING OF ERYTHROCYTE HEMOGLOBINIZATION AND IRON
MARKERS DURING R-HUEPO THERAPY IN ANEMIC PATIENTS WITH MULTIPLE MYELOMA
AND LYMPHOMA
E.K. Katodritou, 1 E. Verrou, 1 D. Kapetanos, 1 A. Banti, 1 C. Kartsios, 1
D. Mihou, 1 V. Gastari, 1 D. Markala, 1 S. Effraimidou, 1 A. Lazaridou, 1
E. Terpos, 2 K. Zervas1 1 2 Theagenion Cancer Center, THESSALONIKI; 251 General Airforce Hospital,
ATHENS, Greece
Background. Recombinant human erythropoietin (r-HuEPO) stimulates
erythropoiesis and increases iron demands in the erythroid marrow
leading to functional iron deficiency (FID). The development of FID is
an important cause of r-huEPO unresponsiveness in anemic patients
with multiple myeloma (MM) and lymphoma. Close monitoring of sensitive
markers of erythrocyte hemoglobinization and iron status are useful
in recognizing FID early in the course of r-huEPO treatment. Aims.
The aim of this study was to monitor the sequential alterations in erythrocyte
hemoglobinization (EH) and iron markers in order to recognize
the development of FID early in the course of r-huEPO treatment, in anemic
patients with MM and lymphoma. Methods. Fourty-one patients
with a median age of 71 years (range 18-84) with symptomatic MM or
lymphoma and disease related anemia, were enrolled. All patients
received epoietin β at a dose of 30.000IU/wk for 6 consecutive weeks.
The evaluated parameters of iron status and EH, were: serum ferritin,
transferrin saturation (TSAT%), soluble transferrin receptor (sTfR), the
ratio of sTfR to the logarithm of ferritin (sTfR-F index), the percentage
of hypochromic erythrocytes (HYPO%) and reticulocyte haemoglobin
content (CHr). These parameters were evaluated in serial measurements
at baseline and on weeks 1, 2 and 6. The gradual development of FID
during sequential weeks was indicated by an increase in HYPO% and
sTfR-F index and a reduction in CHr and TSAT%. Statistical analysis
was performed with paired samples Wilcoxon test and correlations with
the Spearman’s test. Results. HYPO% and sTfR-F index gradually
increased during all sequential measurements showing statistical signif-