Three-month follow-up of high-dose intravenous iron monotherapy for cancer-related anemia in an ESA-free oncology setting: a real-world cohort study.

BACKGROUND

We extended our prior 1-month report to evaluate 3-month hemoglobin (Hb) outcomes, observed transfusion avoidance, and follow-up feasibility after high-dose intravenous iron monotherapy for cancer-related anemia in an erythropoiesis-stimulating agent (ESA)-free oncology setting.

METHODS

This retrospective single-center cohort included adults with active solid malignancy who received high-dose intravenous ferric carboxymaltose or ferric derisomaltose monotherapy. Follow-up was evaluated at prespecified 1-month and 3-month windows. The primary analysis assessed Hb change from baseline to 3 months in evaluable non-transfused patients; observed transfusion avoidance was summarized descriptively.

RESULTS

The cohort comprised 65 patients. In-window Hb was available in 62 patients at 1 month and 42 at 3 months; 27 formed the non-transfused 3-month primary analysis set. Mean Hb increased from 9.01 ± 1.47 g/dL at baseline to 11.09 ± 1.67 g/dL at 3 months (mean change + 2.08 ± 1.72 g/dL; p < 0.001). Hb improvement was greater at 3 months than at 1 month, with a further paired increase among non-transfused patients (+ 0.52 ± 1.27 g/dL; p = 0.043). Observed transfusion avoidance was 81.5% at 1 month and 72.3% across available in-system follow-up within 3 months. Attrition was substantial: 23 patients were non-evaluable for 3-month Hb because of transfer/community follow-up (n = 15), death (n = 7), or data cutoff/window not reached (n = 1).

CONCLUSIONS

In this ESA-free oncology setting, high-dose intravenous iron monotherapy was associated with 3-month Hb improvement in selected evaluable non-transfused patients, with descriptively high observed transfusion avoidance and substantial attrition.