Challenges in the Management of Chemotherapy Related Anemia

Review Article

Ann Hematol Oncol. 2018; 5(3): 1200.

Challenges in the Management of Chemotherapy Related Anemia

Visweshwar N1*, Jaglal M2 and Sokol L2

1Division of Hematology, University of South Florida, USA

2Division of Medical Oncology, Moffitt Cancer Center, USA

*Corresponding author: Visweshwar N, Department of Hematology, University of South Florida, Tampa FL 33612, USA

Received: March 16, 2018; Accepted: April 30, 2018; Published: May 21, 2018


Chemotherapy-induced anemia (CRA) was reported with methotrexate, when it was used in early 50sto treat cancer, and cure patients with choriocarcinoma. Subsequently, CRA has been observed with other chemotherapeutic agents. Patients with CRA have local tumor control from hypoxia and subsequent resistance to chemotherapy and radiotherapy with decreased overall survival. Therefore, CRA requires appropriate intervention. However, there are difficulties in diagnosis and management of CRA, because of the multifactorial etiology of anemia in cancer patients. In spite of several randomized controlled clinical trials and systematic reviews, there is still lack of standardized approach to the management of CRA. We will review the pathophysiology of CRA especially the role of Hepcidin, and discuss algorithm for diagnosis and treatment of CRA. The purpose of this article is to help the clinician stratify the management based on review of available evidence, which may change as future data emerges.

Keywords: Chemotherapy; Anemia; Iron; Erythropoietin; Blood transfusion; Therapy

Pathophysiology of CRA

Chemotherapy-related anemia occurs in about 75% (30%-90%) of cancer patients receiving chemotherapy [1,2]. There is direct inhibition of erythropoiesis by cytokines (interleukin-6, tumor necrosis factor a, interferon gamma and interleukin-1). Interleukin-6 increases production of hepcidin by liver, causing CRA (Figure 1).