scholarly journals Effects of Daily Iron Supplementation on Motor Development and Brain Connectivity in Preterm Infants: A Diffusion Magnetic Resonance Study

2021 ◽  
Vol 15 ◽  
Author(s):  
Mingyan Li ◽  
Chai Ji ◽  
Weifeng Xuan ◽  
Weijun Chen ◽  
Ying Lv ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Serum Ferritin ◽  
Motor Development ◽  
Iron Supplementation ◽  
Brain Connectivity ◽  
Iron Status ◽  
Structural Connectivity ◽  
Brain Regions ◽  
Postnatal Period ◽  
Motor Delay

Objectives: The aim of the study is to demonstrate the characteristic of motor development and MRI changes of related brain regions in preterm infants with different iron statuses and to determine whether the daily iron supplementation can promote motor development for preterm in early infancy.Methods: The 63 preterm infants were grouped into non-anemia with higher serum ferritin (NA-HF) group and anemia with lower serum ferritin (A-LF) group according to their lowest serum Hb level in the neonatal period as well as the sFer at 3 months old. Forty-nine participants underwent MRI scans and Infant Neurological International Battery (INFANIB) at their 3 months. At 6 months of corrected age, these infants received the assessment of Peabody Developmental Motor Scales (PDMS) after 2 mg/kg/day iron supplementation.Results: In total, 19 preterm infants were assigned to the NA-HF group while 44 preterm infants to the A-LF groups. The serum ferritin (sFer) level of the infants in A-LF group was lower than that in NA-HF group (44.0 ± 2.8 mg/L vs. 65.1 ± 2.8 mg/L, p < 0.05) and was with poorer scores of INFANIB (66.8 ± 0.9 vs. 64.4 ± 0.6, p < 0.05) at 3 months old. The structural connectivity between cerebellum and ipsilateral thalamus in the NA-HF group was significantly stronger than that in the A-LF group (n = 17, 109.76 ± 23.8 vs. n = 32, 70.4 ± 6.6, p < 0.05). The decreased brain structural connectivity was positively associated with the scores of PDMS (r = 0.347, p < 0.05). After 6 months of routine iron supplementation, no difference in Hb, MCV, MCHC, RDW, and sFer was detected between A-LF and NA-HF groups as well as the motor scores of PDMS-2 assessments.Conclusion: Iron status at early postnatal period of preterm infant is related to motor development and the enrichment of brain structural connectivity. The decrease in brain structural connectivity is related to the motor delay. After supplying 2 mg/kg of iron per day for 6 months, the differences in the iron status and motor ability between the A-LF and NA-HF groups were eliminated.

scholarly journals Asymmetric high-order anatomical brain connectivity sculpts effective connectivity

2020 ◽  
Vol 4 (3) ◽  
pp. 871-890
Author(s):  
Arseny A. Sokolov ◽  
Peter Zeidman ◽  
Adeel Razi ◽  
Michael Erb ◽  
Philippe Ryvlin ◽  
...  
Keyword(s):  
White Matter ◽  
Dynamic Range ◽  
Diffusion Processes ◽  
Brain Connectivity ◽  
Effective Connectivity ◽  
Structural Connectivity ◽  
Laplacian Matrix ◽  
Graph Laplacian ◽  
Brain Regions ◽  
High Order

Bridging the gap between symmetric, direct white matter brain connectivity and neural dynamics that are often asymmetric and polysynaptic may offer insights into brain architecture, but this remains an unresolved challenge in neuroscience. Here, we used the graph Laplacian matrix to simulate symmetric and asymmetric high-order diffusion processes akin to particles spreading through white matter pathways. The simulated indirect structural connectivity outperformed direct as well as absent anatomical information in sculpting effective connectivity, a measure of causal and directed brain dynamics. Crucially, an asymmetric diffusion process determined by the sensitivity of the network nodes to their afferents best predicted effective connectivity. The outcome is consistent with brain regions adapting to maintain their sensitivity to inputs within a dynamic range. Asymmetric network communication models offer a promising perspective for understanding the relationship between structural and functional brain connectomes, both in normalcy and neuropsychiatric conditions.

Effects of Iron Supplementation on Serum Ferritin and Other Hematological Indices of Iron Status in Menstruating Women

1985 ◽  
Vol 29 (4) ◽  
pp. 232-238 ◽  
Author(s):  
S. Hercberg ◽  
P. Galán ◽  
Y. Soustre ◽  
M.C. Dop ◽  
M. Devanlay ◽  
...  
Keyword(s):  
Serum Ferritin ◽  
Iron Supplementation ◽  
Iron Status ◽  
Hematological Indices ◽  
Menstruating Women

Risk Factors for Iron Deficiency in Very Preterm Infants at 4-6 Months Corrected Age

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 28-28
Author(s):  
Carmen Landry ◽  
Jon Dorling ◽  
Ketan Kulkarni ◽  
Marsha Campbell-Yeo ◽  
Michael Vincer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iron Deficiency ◽  
Preterm Infants ◽  
Serum Ferritin ◽  
Gestational Age ◽  
Iron Supplementation ◽  
Gestational Hypertension ◽  
Univariate Analysis ◽  
P Value

Background: Iron is an essential micronutrient, especially in infants and young children and is required for erythropoiesis and development of the central nervous system. However, iron deficiency (ID) is the most common micronutrient deficiency worldwide. ID and iron deficiency anemia (IDA) have been associated with poor neurodevelopmental and behavioural outcomes later in life. Preterm infants are particularly at risk of developing ID in early life due to lower iron stores at birth, accelerated growth in the first weeks of life and multiple phlebotomies while in hospital. Therefore, international recommendations suggest prophylactic iron therapy of 2-4 mg/kg/day starting at 2-6 weeks of age until at least 6-12 months in preterm and low birth weight infants. This prophylactic iron supplementation has been shown to be effective at reducing the incidence of ID and IDA. However, the published work mainly involves moderate to late preterm infants and the research is lacking on iron status after discharge in very preterm infants (VPI, <31 weeks gestational age). Based on our previous work, 32% of the VPIs were iron deficient at 4-6 months corrected age despite this early supplementation. Since the development of ID may have permanent detrimental effects on the developing brain of these high-risk preterm infants, a knowledge of risk factors for ID is also important to identify strategies focused on its prevention. Objective: To investigate the risk factors associated with development of ID Methods: A retrospective cohort study was conducted at the IWK Health Centre using a population based provincial Perinatal Follow-Up Program database. All live-born VPIs born in Nova Scotia between 2005-2018 were included. Patients with congenital malformations, chromosomal anomalies, or who died prior to outcome assessment were excluded. As a standard of care, all these infants were started on prophylactic iron supplements (2-3 mg/kg/day) at 2-4 weeks of chronological age. Iron dosage was regularly adjusted during the hospital stay as guided by serum ferritin levels. At discharge, it was recommended to continue iron prophylaxis until 9-12 months corrected age. All these infants underwent a blood test during their first neonatal follow-up visit at 4-6 months corrected age to check for hemoglobin, reticulocyte count and serum ferritin. ID was defined as serum ferritin <20g/l or <12g/l at 4 and 6 months respectively. A univariate analysis was performed by using a series of single variable logistic regression models to identify the factors associated with presence of ID. Factors with a p-value < 0.20 in the univariate analysis were entered into a multivariable risk model for occurrence of ID using a backwards selection procedure. Variables with a p-value < 0.05 were retained. Results: Of 411 infants included in the study, 32.1% (n=132) had ID. The prevalence of ID decreased over time (37.6% in 2005-2011 vs 25.8% in 2012-2018 cohort). Table 1 compares the antenatal and neonatal characteristics of the ID and non-ID groups. Table 2 compares sociodemographic variables and clinical variables at the time of follow up of the two groups. Independent risk factors for ID were: gestational age (<27 weeks to >27 weeks) (OR:1.7 (1.0-2.9), p=0.04) and gestational hypertension (OR: 2.1(1.2-3.7), p=0.009). Independent factors protective for ID were: mixed feeding (breast milk and formula compared to formula alone) (OR: 0.5 (0.2-0.9), p=0.021) and iron supplementation at follow-up (OR:0.5 (0.3-0.9), p=0.02). Conclusion(s): Despite prophylactic iron supplementation, one-third of VPIs had ID at 4-6 months corrected age. Gestational hypertension in mother and gestational age < 27 weeks were independent risk factors for ID. In addition, despite adjusting for iron supplementation at follow-up, the formula feeding group was more likely to have ID compared to the mixed feeding group. This may be because of the sub-therapeutic iron intake in the formula fed infants. It is often thought that formula milk may have sufficient iron to meet the demands of growing infants and thus, they are less likely to receive higher doses of supplemental iron beyond what is contained in the formula. However, this may not be true since the iron present in formula may not have the same bioavailability as breast milk. Future prospective studies are required to further validate these observations. Nonetheless, the study identified important areas to mitigate ID in VPIs. Disclosures No relevant conflicts of interest to declare.

High Prevalence of Iron Deficiency In Anemic and Non Anemic Patients with Various Types of Cancer

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5145-5145
Author(s):  
Heinz Ludwig ◽  
Georg Endler ◽  
Brigitte Klement ◽  
Wolfgang Hüubl ◽  
Tim Cushway
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Multiple Testing ◽  
Serum Iron ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Clinical Symptoms ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Patients With Cancer

Abstract Abstract 5145 Introduction and aims: Iron deficiency as a major component in the pathogenesis of anemia in cancer is not acknowledged by most oncologists, possibly except when arising from GI blood loss. Iron deficiency is associated with clinical symptoms such as cognitive impairment, fatigue, and reduced exercise performance. New iron formulations are available that allow rapid iron supplementation with single infusions. This treatment could ameliorate symptoms of iron deficiency and correct anemia. Here, we studied iron parameters and their correlation with erythropoiesis and inflammatory markers in a large unselected cohort of patients with cancer. In addition, we investigated the suitability of serum ferritin and transferrin saturation (TSAT) as parameter for assessment of the iron status. Patients and methods: Data from 1627 patients (median age: 66.4 years, range: 20–97 years) presenting sequentially at the Center for Oncology and Hematology, Wilhelminenspital, Vienna between October 01, 2009 and January 26, 2010, have retrospectively been analyzed. Patients were at different stages of their disease or may not have had an established diagnosis at the time of testing. In patients with multiple testing during this period only the first sample taken was included. TSAT (n=1516), serum ferritin (n=887), serum iron, CRP, and complete blood count, were determined by using standard techniques. Commonly used definitions for absolute iron deficiency (AID), [TSAT <20% and serum ferritin <30ng/ml, in case serum ferritin was not available TSAT <10%] and for functional iron deficiency (FID), [TSAT <20% and serum ferritin ≥30ng/ml, in case serum ferritin was not available TSAT between 10 and 20%] have been applied. Fisher's exact test was used for comparison of frequencies and Pearson's product moment correlation coefficient for evaluation of correlation. Results: Table 1 shows the distribution of TSAT and serum ferritin categories in 1627 patients with cancer. AID was found in 116 patients (7.7%) of the 1516 patients for whom TSAT was available. Eighty-three (72%) of the AID patients presented with anemia (defined by hemoglobin <12g/dl). AID was most common in patients with colorectal and pancreatic cancer (12% and 11%, respectively), and not present in patients with testicular and prostate cancer (p=0.013). FID was diagnosed in 530 patients (35%) and 222 (42%) of them were found to be also anemic. Multivariate analysis revealed a statistically significant correlation between TSAT and serum ferritin (R=0.286, p<0.001), serum iron (R=0.874, p<0.001), hemoglobin (R=0.201, p<0.001) and CRP (R=-0.205, p<0.001) (figure 1). Serum ferritin, in contrast, did not correlate with serum iron (R=0.051, p=0.132), but correlated with hemoglobin (R=-0.259, p<0.001), TSAT (R=0.286, p<0.001), and CRP (R=0.396, p<0.001). Conclusion: AID (7.7%) and even more so FID (35%) are frequent co-morbidities in patients with various types of cancer. Seventy-two percent of patients with AID and 42% with FID presented with overt anemia. TSAT correlated closely with serum iron and hemoglobin levels and seems to be the preferred parameter for assessment of iron status in patients with chronic diseases often complicated by increased inflammation. Serum ferritin was found to be an inadequate parameter for assessment and monitoring of iron status. As iron deficiency has been linked with various symptoms, the question arises whether iron supplementation would benefit patients with FID without overt anemia. Future studies should evaluate the role of novel intravenous iron preparations in ameliorating the symptoms of iron deficiency with or without anemia. Disclosures: Klement: Vifor Pharma Ltd: Employment. Cushway:Vifor Pharma Ltd.: Employment.

scholarly journals Unique mapping of structural and functional connectivity on cognition

2018 ◽  
Author(s):  
J. Zimmermann ◽  
J.G. Griffiths ◽  
A.R. McIntosh
Keyword(s):  
Functional Connectivity ◽  
Brain Connectivity ◽  
Structural Connectivity ◽  
Brain Regions ◽  
Unique Mapping ◽  
Human Connectome Project ◽  
Behavioural Patterns ◽  
Wide Range ◽  
Psychological Tasks ◽  
New Evidence

AbstractThe unique mapping of structural and functional brain connectivity (SC, FC) on cognition is currently not well understood. It is not clear whether cognition is mapped via a global connectome pattern or instead is underpinned by several sets of distributed connectivity patterns. Moreover, we also do not know whether the pattern of SC and of FC that underlie cognition are overlapping or distinct. Here, we study the relationship between SC and FC and an array of psychological tasks in 609 subjects from the Human Connectome Project (HCP). We identified several sets of connections that each uniquely map onto different aspects of cognitive function. We found a small number of distributed SC and a larger set of cortico-cortical and cortico-subcortical FC that express this association. Importantly, SC and FC each show unique and distinct patterns of variance across subjects and differential relationships to cognition. The results suggest that a complete understanding of connectome underpinnings of cognition calls for a combination of the two modalities.Significance StatementStructural connectivity (SC), the physical white-matter inter-regional pathways in the brain, and functional connectivity (FC), the temporal co-activations between activity of brain regions, have each been studied extensively. Little is known, however, about the distribution of variance in connections as they relate to cognition. Here, in a large sample of subjects (N = 609), we showed that two sets of brain-behavioural patterns capture the correlations between SC, and FC with a wide range of cognitive tasks, respectively. These brain-behavioural patterns reveal distinct sets of connections within the SC and the FC network and provide new evidence that SC and FC each provide unique information for cognition.

scholarly journals The R1-weighted connectome: complementing brain networks with a myelin-sensitive measure

2020 ◽  
pp. 1-15
Author(s):  
Tommy Boshkovski ◽  
Ljupco Kocarev ◽  
Julien Cohen-Adad ◽  
Bratislav Mišić ◽  
Stéphane Lehéricy ◽  
...  
Keyword(s):  
White Matter ◽  
Diffusion Mri ◽  
Brain Connectivity ◽  
Structural Connectivity ◽  
Brain Regions ◽  
Added Value ◽  
Modular Organization ◽  
Sensitive Measure ◽  
Higher Order Functions ◽  
Insight Into

Myelin plays a crucial role in how well information travels between brain regions. Complementing the structural connectome, obtained with diffusion MRI tractography, with a myelin-sensitive measure could result in a more complete model of structural brain connectivity and give better insight into white-matter myeloarchitecture. In this work we weight the connectome by the longitudinal relaxation rate (R1), a measure sensitive to myelin, and then we assess its added value by comparing it with connectomes weighted by the number of streamlines (NOS). Our analysis reveals differences between the two connectomes both in the distribution of their weights and the modular organization. Additionally, the rank-based analysis shows that R1 can be used to separate transmodal regions (responsible for higher-order functions) from unimodal regions (responsible for low-order functions). Overall, the R1-weighted connectome provides a different perspective on structural connectivity taking into account white matter myeloarchitecture.

scholarly journals Regulatory Mechanisms for Iron Homeostasis Are Present in Small Preterm Newborns

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2460-2460
Author(s):  
Carina Levin ◽  
Marina Marina Peniakov ◽  
Dan Reich ◽  
Scott Weiner ◽  
Jamal Hasnein ◽  
...  
Keyword(s):  
Birth Weight ◽  
Blood Transfusion ◽  
Preterm Infants ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Reticulocyte Count ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Regulatory Mechanisms ◽  
Vlbw Infants

Abstract Iron, an essential micronutrient, plays an important role in cellular functions. To prevent deficiency, iron supplementation is universally recommended for preterm infants; nevertheless, assessment of newborn iron stores is not currently recommended. Both iron deficiency and iron excess early in life can have adverse effects on neurodevelopment and outcomes, and therefore sensitive and specific methods for evaluating iron status and determining optimal iron supplementation are essential. The current study aimed to evaluate iron status and iron-supplementation efficacy/toxicity in preterm infants using new laboratory methods, and to correlate iron status with clinical, nutritional, laboratory and therapeutic factors, and the amount of blood extracted and transfused. We evaluated 50 very low birth weight (VLBW) preterm infants treated under standard protocols at the Emek Medical Center NICU, 26 (54%) male. Iron supplementation was administered enterally from 4 wk of age (4 mg elemental iron/kg body weight daily). Laboratory studies included CBC, reticulocyte count, reticulocyte hemoglobin (Hb) content, iron, transferrin, transferrin saturation, ferritin, erythropoietin, hepcidin, CRP and non-transferrin-bound iron (NTBI) (Aferrix, Israel). Samples were obtained at 3 different times during hospitalization: (-0) before starting oral iron supplementation, (-1) on d 4-7 of supplementation, and (-2) after at least 2 wk of supplementation. To better understand iron metabolism, the analyzed preterm population was divided into subgroups for comparison: infants who did not require blood transfusion (No-BT) vs. those who received one or more transfusions (BT); infants who did not show abnormal NTBI levels (≤0.19 μmol/L; No-NTBI) vs. those with abnormal NTBI levels (≥ 0.2 μmol/L in one or more samples; NTBI). Mean birth weight of the studied infants was 1264.5 ± 342 g, gestational age 29.1 ± 2.5 wk, age at hospital discharge 57.6 ± 20 d and weight at discharge, 2412 ± 421 g. The BT group included 35 (70%) infants. The mean birth weight was lower in the BT vs. No-BT group (1199 ± 351 g vs. 1416±273 g, P = 0.04). Mean red blood cell, Hb, and hematocrit were higher in the BT vs. No-BT group. Conversely, mean platelet count, reticulocyte count, and erythropoietin were higher in the No-BT vs. BT group, suggesting an erythropoietic response to lower Hb levels and utilization of iron through effective erythropoiesis. In the BT group, mean serum iron, ferritin, transferrin saturation and hepcidin were higher, whereas transferrin was lower than in the No-BT group. This reflects increased iron burden induced by the transfusions, making NTBI more likely to develop with potential toxicity. Regarding NTBI, 34 (68%) of the infants were in the No-NTBI group, and 16 (32%) showed increased NTBI levels. The Δiron (sum of iron from diet, supplementation and transfusion minus iron output via blood extractions) before starting supplementation was significantly higher in the NTBI vs. No-NTBI group. Mean transferrin saturation at -0 was higher, whereas transferrin at -2 was lower in the NTBI vs. No-NTBI group, demonstrating a higher iron burden in NTBI infants. The odds of developing NTBI rose 7.2% for each percent increment in transferrin saturation at -0 (O.R. 1.072, 95% CI, 1.005-1.143, P = 0.036), and a cutoff of 26% at -0 gave 80% sensitivity and 41% specificity for the presence of NTBI (AUC 0.68). Thus VLBW infants show evidence of regulatory mechanisms for iron homeostasis and iron utilization for erythropoiesis; however, the protective responses are not developed enough to limit the appearance of circulating free iron with potential toxic effects. Neither adverse effects nor presence of NTBI were associated with enteral iron supplementation. Premature infants who received blood transfusions had a positive iron balance, higher Hb and ferritin levels, and reduced erythropoiesis. Consequently, these babies are more likely to develop free iron. Conventional biomarkers are effective for evaluating iron status in VLBW infants. Transferrin saturation seems to be the most reliable and "physiological" biomarker, and a potential predictor of abnormal NTBI levels. These findings support an individualized approach to iron supplementation based on the characteristics of the specific preterm infant while taking into consideration past need for blood transfusion and the infant's iron status. Disclosures No relevant conflicts of interest to declare.

Assessment of Iron Status in Hemoglobin E and b Thalassemia Carriers

2021 ◽  
Vol 36 (1) ◽  
pp. 25-33
Author(s):  
Md Anwarul Karim ◽  
Chowdhury Yakub Jamal ◽  
Md Selimuzzaman ◽  
MA Mannan Miah
Keyword(s):  
Serum Ferritin ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Iron Status ◽  
Statistical Significance ◽  
Deficiency Anemia ◽  
P Value ◽  
Iron Level ◽  
Hemoglobin E ◽  
Female Ratio

Background: About 10-13% people of Bangladesh are carrier of HbE and b- thalassaemia. Many program have been taken by Government and NGOs for supplementation of iron to raise hemoglobin level of children which may not be beneficial or might be harmful to the carriers of this disease. Objectives: of the study was to assess the iron status of Hemoglobin E and b thalassemia carriers thereby to develop iron supplementation strategy for these carriers. Methods: This cross sectional analytic study was on 206 carriers of Hemoglobin E and b thalassemia and 54 healthy controls. Complete blood count with RBC indices, Hemoglobin (Hb) electrophoresis and serum ferritin, serum iron and TIBC were carried out for all subjects following standard protocol. Data were analyzed by Statistical Package for Social Science (SPSS) Version 12. Results: Among 260 subjects 206 were carriers and 54 were control. Number of male was 137 and female was 123 and male to female ratio was 1.1:1. Age of the subjects ranges from 1 year to 59 years with a mean age (±SEM) of 23.07± 0.84 years. Mean age (±SEM) of cases was 22.78 ± 0.971 years and that of control was 24.17 ± 1.63 years. Hematological parameters such as mean (±SEM) Hb concentration, MCV, MCH, and MCHC of carriers were significantly low as compared to the control (p value < 0.01 in all comparison). Mean serum ferritin and iron level in carriers were higher than control however; statistical significance between the values were not found (p value >0.5). Out of 206 carriers 27 (13.1%) cases had IDA and it’s frequency was similar among HbE (14.2%) and thalassemia carriers (12.2%) and prevalence of IDA among the carriers were high (37.5 %) in age group 1-5 years which rises to 52.5% in under nourished children. Conclusion: Carriers of HbE and b thalassemia do have relatively higher iron profile as compared to control but not statistically significant. Iron deficiency anemia is not uncommon in carriers especially in children. So there is no contraindication of iron supplementation to the children in general. DS (Child) H J 2020; 36(1) : 25-33

Effectiveness Of Biosimilar Epoetin Alfa For The Treatment Of Chemotherapy-Induced Anemia In Patients With Hematological Malignancies

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3430-3430 ◽  
Author(s):  
Samir G. Agrawal ◽  
Andrea Guy ◽  
Patricia O'Flaherty ◽  
Matthew Turner
Keyword(s):  
Pilot Study ◽  
Serum Ferritin ◽  
Iron Supplementation ◽  
Hematological Malignancies ◽  
Iron Status ◽  
Response Rates ◽  
Epoetin Alfa ◽  
American Society ◽  
Biosimilar Epoetin Alfa ◽  
Very High

Abstract Background Epoetin and intravenous iron are used at St. Bartholomew's Hospital (Barts Health NHS Trust) for the treatment of patients with non-myeloid malignancy and chemotherapy-induced anemia. Modified American Society of Hematology/American Society of Clinical Oncology guidelines are used to guide epoetin use. This is combined with a systematic approach to iron supplementation based on iron status markers, including zinc protoporphyrin (ZPP). Using this approach, we have previously reported very high hemoglobin response rates of up to 92% with epoetin beta (Agrawal et al. Blood 2005; 106: Abs 588). Biosimilar versions of epoetin alfa are now approved in Europe to treat chemotherapy-induced anemia in patients with cancer. These agents offer potentially substantial cost savings to healthcare payers, and their greater affordability may increase patient access to treatments. We performed a pilot study of the effectiveness of biosimilar epoetin alfa (Sandoz, Germany) in our protocol for the management of chemotherapy-induced anemia in patients with hematological malignancies. Methods Patients with chronic lymphocytic leukemia (CLL), myeloma or lymphoma, receiving chemotherapy and with Hb<10 g/dL, were treated with biosimilar epoetin alfa (30,000 IU subcutaneously once weekly, increased to 60,000 IU at 4 weeks if no response [Hb increase<1 g/dL over baseline]). Minor and major responses to epoetin were defined as a Hb increase of 1–2 g/dL and >2 g/dL, respectively. Iron support was given in the form of intravenous (i.v.) iron sucrose 200 mg weekly if indicated based on iron status markers (serum ferritin, transferring saturation [TSAT], mean corpuscular Hb [MCH] and ZPP). Results Nineteen patients treated with biosimilar epoetin alfa were included in this analysis (9 with CLL, 7 with myeloma, 3 with lymphoma). Ages ranged from 25 to 84 years. 18 patients had a response to biosimilar epoetin alfa (95%); of these, 12 had a major response and 6 a minor response. Only one patient required an epoetin dose increase. Four patients were transfusion-dependent at baseline, 3 of whom became transfusion-independent on epoetin therapy. Seven of the 19 patients were ineligible for iron supplementation because of a serum ferritin >1000 μg/L. Of the remaining 12 patients, five (43%) received i.v. iron support based on their iron status markers at baseline and during epoetin therapy. In all five, the trigger for iron support was a raised ZPP in combination with a low/normal serum ferritin; TSAT was low in only 2/5and the MCH was normal in 5/5. All five patients achieved a response to epoetin. In contrast, five other patients who had a raised ZPP did not receive iron support because of markedly raised serum ferritin (>750 μg/L) with raised TSAT. Conclusions This pilot study indicates that biosimilar epoetin alfa is effective for the treatment of chemotherapy-induced anemia in patients with hematological malignancies. Although this is a small data set, response rates using biosimilar epoetin alfa in our epoetin/iron supplementation protocol (95%) are very high and similar to historical data using epoetin beta (92%). While ZPP appears to be a useful parameter to guide iron support in patients with hematological malignancies, it cannot be used in isolation and must be correlated with serum ferritin. Appropriate use of iron support, based on assessment of readily available laboratory parameters, may increase response rates to epoetin therapy. Disclosures: Agrawal: Sandoz Biopharmaceuticals: Consultancy, Honoraria, Research Funding. Turner:Sandoz Biopharmaceuticals: Employment.

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