This is an extremely well conducted, difficult meta-analysis. The data were carefully scrutinized and a conservative approach was taken to draw conclusions which are consistent with 12 of 12 studies, without contradictory data, showing a clear benefit for intravenous (IV) iron when added to the treatment paradigm of chemotherapy- and cancer-associated anemia. The authors could have been even stronger in their conclusions as the impact of the second Steensma reference, for all intents and purposes, eliminated the last vestige of doubt about the benefit of IV iron in these settings. Steensma had the temerity and clarity to stratify the patients in the treatment arm to those who received at least 80% of the prescribed dose and to those who did not. They confirmed that the other eleven studies showed a benefit for IV iron.

We owe the authors of this study a debt of gratitude for providing such a well-done analysis. Hopefully works like these will result in a standard recommendation for routine IV iron administration in chemotherapy-induced anemia, among the different bodies that publish guidelines.

– Michael Auerbach