The authors conducted a randomized study of erythropoiesis-stimulating agent (ESA) therapy, with or without intravenous (IV) iron supplementation, compared to no treatment, beginning day 28 in patients post autologous stem cell transplantation for multiple myeloma or lymphoma. The primary endpoint was the proportion of patients achieving normal hemoglobin levels by day 126 of therapy: 24%, 79%, and 100% in patients receiving no treatment, darbepoetin alfa (300 micrograms every two weeks); and darbepoetin alfa (300 micrograms) plus IV iron (200 mg) on days 28, 42, and 56, respectively.
The higher erythropoietic response with ESA plus IV iron therapy was accompanied by a modest but significant transfusion-sparing effect: 5 of 45 patients treated with ESA alone received RBC transfusions, compared to 0 of 46 patients who were treated with ESA plus IV iron (P = 0.03). Approximately 40% of patients showed evidence of functional iron deficiency (TSAT < 20%), accounting for the observed benefit of IV iron therapy in association with ESA therapy. This study provides insight into the value of ESA and IV iron therapy to insure complete erythropoietic response after autologous stem cell transplantation. – Lawrence Tim Goodnough