Hypochromic Reticulocytes And Ferritin Index In The Diagnosis Of Cancer- And Chemotherapy-Related Anemia

20705 Background: Iron monitoring is mandatory in erythropoiesis stimulating factor therapy. Thomas et al. (Clin Chem 2002;48:1066–76) combined the reticulocyte hemoglobin (Hb) content (CHr) with the C-reactive protein (CRP)-dependent ferritin (Fer) index (FI: soluble transferrin receptor/log Fer ratio) in a diagnostic plot. We conducted a prospective phase II trial to analyze the diagnostic value of CHr, FI and the diagnostic plot in anemic chemotherapy (ChT)-treated cancer patients (pts). Methods: The diagnostic plot assigned informed consenting pts with Hb <11 g/dl and Fer >20 ng/ml into 1 of 4 quadrants (Q1–4): those with FI values above threshold (FI ≥2.0 if CRP <5 mg/l, or FI ≥3.2 if CRP ≥5 mg/l) to Q2 (CHr >28 pg) or Q3 (CHr ≤28 pg), and those with subthreshold FI values to Q1 (CHr >28 pg) or Q4 (CHr ≤28 pg). Results: 11 centers recruited 303 pts (median age 65 y, 59% female) from 10/04 to 10/06; 207 (68%) fell in Q1. Only 50 pts (27 Q3 + 23 Q4; 17%) had CHr ≤28 pg; 63 (46 Q2 + 27 Q3; 21%) had an increased FI, indicating relative iron deficiency. Q1–4 assignment did not correlate with age, gender, body mass index, cancer type or stage, measurable metastasis, bone marrow infiltration, performance status, endogenous erythropoietin level, or hematocrit. However, Hb was lower and CRP higher in Q4, RBC was higher in Q2+3, and leukocytes and platelets (PLT) were higher in Q3+4. Transferrin saturation (TSAT) was higher in Q1. Fer correlated positively overall with CRP. Both CHr and TSAT correlated negatively with CRP. Conclusions: Analysis of CRP, FI and CHr in ChT-treated cancer anemia shows unexpectedly few pts (17%) with hypochromic reticulocytes (CHr ≤28 pg), high ferritin and CRP indicative of inflammation-induced functional iron deficiency, but also 21% of pts with inadequate iron stores. Supported by Roche-Pharma AG, Grenzach-Wyhlen, Germany. Hypochromic reticulocytes and ferritin index (mean ± SD) N 303 FI ≥ threshold* FI ≥ threshold* CHr >28 pg Q2 N 46 (15.2%) Q2 N 46 (15.2%) Hb g/dl 10.2 ± 1.1 10.2 ± 1.1 RBC 106/μl 4.1 ± 4.7 4.1 ± 4.7 WBC 103/μl 6.5 ± 9.6 6.5 ± 9.6 PLT 103/μl 238.6 ± 131.3 238.6 ± 131.3 TSAT % 21 ± 16.2 21 ± 16.2 CRP mg/l 32 ± 50 32 ± 50 CHr ≤28 pg Q3 N 27 (9%) Q3 N 27 (9%) Hb g/dl 9.8 ± 1 9.8 ± 1 RBC 106/μl 3.8 ± 0.5 3.8 ± 0.5 WBC 103/μl 9.9 ± 16.9 9.9 ± 16.9 PLT 103/μl 319.5 ± 152.8 319.5 ± 152.8 TSAT % 16.6 ± 13.8 16.6 ± 13.8 CRP mg/l 33.2 ± 43.4 33.2 ± 43.4 * FI ≥2.0 if CRP <5 mg/l, or FI ≥3.2 if CRP ≥5 mg/l Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Roche Amgen, Ortho Biotech, Roche Roche