Pathogenetic Characteristics of Anemia in Patients with Solid Tumors

Valery Timofeevich Sakhin, E.R. Madzhanova, E.V. Kryukov, A.V. Sotnikov, A.V. Gordienko, O.A. Rukavitsyn,

DOI:

https://doi.org/10.21320/2500-2139-2017-10-4-208-217

Aim. To study the impact iron metabolism disturbances and cytokine levels on the development of anemia in patients with solid tumors.

Materials & Methods. The research included 42 patients with malignant neoplasms, including 24 patients with anemia (19 men and 5 women, median age 67.7 ± 10 years) and 18 patients without anemia (15 men, 3 women, median age 65.7 ± 14 years). Anemia was diagnosed according to the WHO criteria (in men: erythrocytes < 4.0 × 1012/L, hemoglobin < 130 g/L, hematocrit < 39 %; in women: erythrocytes < 3.8 × 1012/L, hemoglobin < 120 g/L, hematocrit < 36 %).

Results. A comparative analysis of iron metabolism in patients with and without anemia was performed. The lower values of serum iron and transferrin saturation in patients with anemia were shown (p < 0.05). The total iron-binding capacity, the levels of ferritin, transferrin, C-reactive protein, indirect bilirubin were similar between groups (p > 0,05). Higher levels of interleukins 6 and 10 (IL-6 and IL-10) were observed in patients with anemia (p < 0.05). For IL-6, correlations were observed with levels of erythrocytes (r = –0,58), hemoglobin (r = –0,57), hematocrit (r = –0,52), and leukocytes (r = 0,42). The levels of IL-10 slightly correlated with the levels of erythrocytes, leukocytes, platelets, MCV, and MCH (r < 0.3). For IL-10, correlations were established with levels of MCHC (r = –0,71), hemoglobin (r = –0,64) and hematocrit (r = –0,32). Correlations between the levels IL-6, IL-6 and hemoglobin, erythrocytes and several color indices may indicate their influence on the development of anemia in patients with malignant neoplasms.

Conclusion. A functional iron deficiency in patients with anemia was found. Several causes of anemia development and significant role of interleukins in anemia pathogenesis were also discovered.

  • Valery Timofeevich Sakhin 1586 Military Clinical Hospital, 4 Mashtakova str., Podolsk, Russian Federation, 142110 ; ФГКУ «1586 Военный клинический госпиталь» Минобороны России, ул. Маштакова д. 4, Московская область, Подольск, Российская Федерация, 142110
  • E.R. Madzhanova 1586 Military Clinical Hospital, 4 Mashtakova str., Podolsk, Russian Federation, 142110 ; ФГКУ «1586 Военный клинический госпиталь» Минобороны России, ул. Маштакова д. 4, Московская область, Подольск, Российская Федерация, 142110
  • E.V. Kryukov NN Burdenko Main Military Clinical Hospital, 3 Gospitalnaya sq., Moscow, Russian Federation, 105229 ; ФГКУ «Главный военный клинический госпиталь им. Н.Н. Бурденко» Минобороны России, Госпитальная пл., д. 3, Москва, Российская Федерация, 105229
  • A.V. Sotnikov SM Kirov Military Medical Academy, 6 Akademika Lebedeva str., Saint Petersburg, Russian Federation, 194044 ; ФГБВОУ ВПО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, ул. Академика Лебедева, д. 6, Санкт-Петербург, Российская Федерация, 194044
  • A.V. Gordienko SM Kirov Military Medical Academy, 6 Akademika Lebedeva str., Saint Petersburg, Russian Federation, 194044 ; ФГБВОУ ВПО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, ул. Академика Лебедева, д. 6, Санкт-Петербург, Российская Федерация, 194044
  • O.A. Rukavitsyn NN Burdenko Main Military Clinical Hospital, 3 Gospitalnaya sq., Moscow, Russian Federation, 105229 ; ФГКУ «Главный военный клинический госпиталь им. Н.Н. Бурденко» Минобороны России, Госпитальная пл., д. 3, Москва, Российская Федерация, 105229
  1. Maccio A, Madeddu C, Gramignano G, et al. The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study. Haematologica. 2015;100(1):124–32. doi: 10.3324/haematol.2014.112813. DOI: https://doi.org/10.3324/haematol.2014.112813
  2. Ludwig H, Van Belle S, Barrett-Lee P, et al. The European Cancer Anaemia Survey (ECAS): A large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40(15):2293–306. doi: 10.1016/j.ejca.2004.06.019. DOI: https://doi.org/10.1016/j.ejca.2004.06.019
  3. Steinmetz T, Totzke U, Schweigert M, et al. A prospective observational study of anaemia management in cancer patients–results from the German Cancer Anaemia Registry. Eur J Cancer Care. 2011;20(4):493–502. doi: 10.1111/j.1365-2354.2010.01230.x. DOI: https://doi.org/10.1111/j.1365-2354.2010.01230.x
  4. Waters JS, O’Brien MER, Ashley S. Management of anemia in patients receiving chemotherapy. J Clin Oncol. 2002;20(2):601–3. doi: 10.1200/JCO.2002.20.2.601. DOI: https://doi.org/10.1200/JCO.2002.20.2.601
  5. Grotto HZ. Anaemia of cancer: an overview of mechanisms involved in its pathogenesis. Med Oncol. 2008;25(1):12–21. doi: 10.1007/s12032-007-9000-8. DOI: https://doi.org/10.1007/s12032-007-9000-8
  6. Гематология: национальное руководство. Под ред. О.А. Рукавицына. М.: ГЭОТАР-Медиа, 2015. С. 143–9.[Rukavitsyn OA, ed. Gematologiya: natsional’noe rukovodstvo. (Hematology: national guidelines.) Moscow: GEOTAR-Media Publ.; 2015. pp. 143–9 (In Russ)]
  7. Ludwig H, Muldur E, Endler G, et al. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24(7):1886–92. doi: 10.1093/annonc/mdt118. DOI: https://doi.org/10.1093/annonc/mdt118
  8. de Castro J, Gascоn P, Casas A, et al. Iron deficiency in patients with solid tumours: prevalence and management in clinical practice. Clin Transl Oncol. 2014;16(9):823–8. doi: 10.1007/s12094-013-1155-5. DOI: https://doi.org/10.1007/s12094-013-1155-5
  9. Beguin Y. Prediction of response and other improvements on the limitations of recombinant human erythropoietin therapy in anemic cancer patients. Haematologica. 2002;87(11):1209–21.
  10. Steinmetz HT, Tsamaloukas A, Schmitz S, et al. A new concept for the differential diagnosis and therapy of anaemia in cancer patients. Support Care Cancer. 2010;19(2):261–9. doi: 10.1007/s00520-010-0812-2. DOI: https://doi.org/10.1007/s00520-010-0812-2
  11. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011–23. doi: 10.1056/nejmra041809. DOI: https://doi.org/10.1056/NEJMra041809
  12. Maccio A, Madeddu C, Massa D, et al. Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia. Blood. 2005;106(1):362–7. doi: 10.1182/blood-2005-01-0160. DOI: https://doi.org/10.1182/blood-2005-01-0160
  13. Falkensammer CE, Thurnher M, Leonhartsberger N, Ramoner R. C-reactive protein is a strong predictor for anaemia in renal cell carcinoma: role of IL-6 in overall survival. BJU Int. 2011;107(12):1893–8. doi: 10.1111/j.1464-410x.2010.09817.x. DOI: https://doi.org/10.1111/j.1464-410X.2010.09817.x

Keywords:

cancer, anemia, iron metabolism, interleukin-6, interleukin-10

License

Copyright (c) 2017 Clinical Oncohematology

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Downloads

Download data is not yet available.

Author Biography

  • Valery Timofeevich Sakhin, 1586 Military Clinical Hospital, 4 Mashtakova str., Podolsk, Russian Federation, 142110, ФГКУ «1586 Военный клинический госпиталь» Минобороны России, ул. Маштакова д. 4, Московская область, Подольск, Российская Федерация, 142110

    PhD

2017-4

Downloads

Published

01.10.2017

Issue

Vol. 10 No. 4 (2017)
ANEMIAS

How to Cite

Sakhin V.T., Madzhanova E.R., Kryukov E.V., Sotnikov A.V., Gordienko A.V., Rukavitsyn O.A. Pathogenetic Characteristics of Anemia in Patients with Solid Tumors. Clinical Oncohematology. Basic Research and Clinical Practice. 2017;10(4):514–518. doi:10.21320/2500-2139-2017-10-4-208-217.

Most read articles by the same author(s)