# Potential Benefit of Intravenous Iron Monotherapy for Grade 2–3 Chemotherapy-Induced Anemia Irrespective of Transferrin Saturation Levels

## TL;DR

Intravenous iron therapy can help some cancer patients with moderate to severe anemia from chemotherapy, regardless of their iron levels.

## Contribution

This study shows IV iron monotherapy is effective for CIA even without checking transferrin saturation.

## Key findings

- 40% of patients with severe CIA responded to IV iron therapy with Hb increase ≥1 g/dL in one month.
- Response rates were similar in patients with TSAT <20% and TSAT ≥20%.
- Ferritin levels or iron dose were not significantly associated with treatment response.

## Abstract

Background

High-dose intravenous (IV) iron monotherapy has been evaluated for chemotherapy-induced anemia (CIA), but prior studies mainly focused on patients with hemoglobin (Hb) levels around 10 g/dL. Its efficacy in more severe anemia and the predictive value of transferrin saturation (TSAT) remain unclear.

Methodology

We retrospectively reviewed cancer patients who underwent chemotherapy and received intravenous ferric carboxymaltose or ferric derisomaltose. The primary endpoint was an Hb increase of ≥1 g/dL within one month, with patients classified as responders, and response rates were compared using a TSAT cutoff of 20%. Hb measurements obtained after delays or discontinuation of chemotherapy were censored.

Results

Twenty patients (median pretreatment Hb, 8.5 g/dL; range, 6.9-9.7 g/dL) were included in this study. Eight patients (40%) achieved an Hb increase of ≥1 g/dL within one month. Response rates were 36% in patients with TSAT <20% and 40% in those with TSAT ≥20%. No significant association was observed with serum ferritin levels or iron dose.

Conclusions

IV iron monotherapy has potential benefit in a subset of patients with grade 2-3 CIA. Routine measurement of TSAT or ferritin may not be necessary in daily practice, particularly for patients who are ineligible for erythropoiesis-stimulating agent therapy.