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Addition of intravenous iron to epoetin beta increases hemoglobin response and decreases epoetin dose requirement in anemic patients with lymphoproliferative malignancies: a randomized multicenter study

A Corrigendum to this article was published on 13 February 2008


This randomized study assessed if intravenous iron improves hemoglobin (Hb) response and permits decreased epoetin dose in anemic (Hb 9–11 g/dl), transfusion-independent patients with stainable iron in the bone marrow and lymphoproliferative malignancies not receiving chemotherapy. Patients (n=67) were randomized to subcutaneous epoetin beta 30 000 IU once weekly for 16 weeks with or without concomitant intravenous iron supplementation. There was a significantly (P<0.05) greater increase in mean Hb from week 8 onwards in the iron group and the percentage of patients with Hb increase 2 g/dl was significantly higher in the iron group (93%) than in the no-iron group (53%) (per-protocol population; P=0.001). Higher serum ferritin and transferrin saturation in the iron group indicated that iron availability accounted for the Hb response difference. The mean weekly patient epoetin dose was significantly lower after 13 weeks of therapy (P=0.029) and after 15 weeks approximately 10 000 IU (>25%) lower in the iron group, as was the total epoetin dose (P=0.051). In conclusion, the Hb increase and response rate were significantly greater with the addition of intravenous iron to epoetin treatment in iron-replete patients and a lower dose of epoetin was required.

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We thank the patients and study nurses for their dedication to this trial. We thank Karin Larsson for monitoring and assisting and Ulf Jansson for excellent laboratory work. We also thank the NIFe Study Group for its participation in this study; a complete membership list appears in ‘ Appendix.’ This work was supported by grants from Roche AB, Sweden, and the Research and Development Centre, Sundsvall Hospital, Sundsvall, Sweden. This investigator-initiated study was supported in part by research funding from Roche AB, Sweden.

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Correspondence to M Hedenus.



The NIFe study group included the following individuals and centers

Jesper Aagesen, Department of Medicine, Jönköping Hospital; Lucia Ahlberg, Department of Medicine, University Hospital, Linköping; Gunnar Birgegård, Department of Hematology, Akademiska Hospital; Margareta Carlsson, Department of Medicine, Växjö Hospital; Leif Enquist, Department of Medicine, Värnamo Hospital; Torbjörn Karlsson, Department of Medicine, St Görans Hospital; Sören Hanssen, Department of Medicine, Högland Hospital; Michael Hedenus, Department of Medicine, Sundsvall Hospital; Gerd Lärfars, Department of Medicine, Södersjukhuset; Birgitta Lauri, Department of Medicine, Sunderby Hospital; Olof Lindquist, Department of Medicine, Uddevalla Hospital; Jeanette Lundin, Departments of Hematology and Oncology, Karolinska University Hospital; Per Näsman, Center for Safety Research, Royal Institute of Technology; Göran Nilsson, Department of Medicine, Östra Hospital; Herman Nilsson-Ehle, Medical Department, Sahlgrenska University Hospital; Anders Österborg, Departments of Hematology and Oncology, Karolinska University Hospital; Fredrik Sjöö, Department of Medicine, St Görans Hospital, and Kristina Wallman, Medical Department, Falun Hospital.

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Hedenus, M., Birgegård, G., Näsman, P. et al. Addition of intravenous iron to epoetin beta increases hemoglobin response and decreases epoetin dose requirement in anemic patients with lymphoproliferative malignancies: a randomized multicenter study. Leukemia 21, 627–632 (2007).

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  • anemia
  • cancer
  • erythropoietin
  • intravenous iron
  • lymphoproliferative malignancies

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