2018, Number 3
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Rev Hematol Mex 2018; 19 (3)
Increased hemoglobin in patients with chronic inflammatory anemia treated with low-dose thalidomide
Ron-Guerrero CS, Ron-Magaña AL, López-Flores JF
Language: Spanish
References: 36
Page: 123-132
PDF size: 295.18 Kb.
ABSTRACT
Background: Anemia of chronic disease is the first cause of anemia in hospitalized
patients. It is usually associated with a chronic inflammatory disease.
Objective: To test the effectiveness of thalidomide in increasing hemoglobin levels
in patients with anemia of chronic disease.
Material and Method: A clinical study was done with adult women with anemia of
chronic disease from the Hematology clinic of the General Hospital Dr. Aquiles Calles
Ramírez, Nayarit, Mexico, from February 1
st 2015 to January 31 2017. They were assigned
by convenience in three groups, to administer ferrous sulfate (FS), thalidomide
or ferrous sulfate and thalidomide, respectively. They were followed for 90 days after
having collecting their baseline laboratory measurements. Hemoglobin means and
hematological data were compared using the parametric tests of ANOVA and Student
t test, or in case of not fulfilling the assumption of normality, the Kruskal-Wallis and
Mann-Whitney U tests were used.
Results: The average hemoglobin level in patients treated with thalidomide increased
from 10.5 ± 0.66 to 11.9 ± 1.05 g/dL, with ferrous sulfate increased from 10.1 ± 1.25
to 11.5 ± 0.87 g/dL and with thalidomide/ferrous sulfate increased from 9.5 ± 0.96 to
11.8 ± 1.28 g/dL. The significance was p ‹ 0.001 in each of the arms.
Conclusion: Thalidomide is effective in anemia of chronic disease and shows
synergism when ferrous sulfate is added.
REFERENCES
Wong P, Intragumtornchai T. Hospital-acquired anemia. J Med Assoc Thai 2006;89:63-67.
Cash JM, Sears DA. The anemia of chronic disease: spectrum associated diseases in a series of unselected hospitalized patients. Am J Med 1989;87(6):638.
Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005;352 (10):1011.
van Iperen CE, van de Wiel A, Marx JJ. Acute event-related anaemia. Br J Haematol 2001;115:739.
Rodriguez RM, Corwin HL, Gettinger A, et al. Nutritional deficiencies and blunted erythropoietin response as causes of the anemia of critical illness. J Crit Care 2001;16:36.
Corwin HL, Gettinger A, Pearl RG, et al. Efficacy of recombinant human erythropoietin in critically ill patients: a randomized controlled trial. JAMA 2002;288:2827.
Raj DS. Role of interleukin-6 in the anemia of chronic disease. Sem Arthritis Rheum 2009;38(5):382.
Wang CQ, Udupa KB, Lipschitz DA. Interferon-gamma exerts its negative regulatory effect primarily on the earliest stages of murine erythroid progenitor cell development. J Cell Physiol 1995;162:134-8.
Taniguchi S, Dai CH, Price JO, Krantz SB. Interferon gamma downregulates stem cell factor and erythropoietin receptors but not insulin-like growth factor-I receptors in human erythroid colony-forming cells. Blood 1997;90:2244.
Zarychanski R, Houston DS. Anemia of chronic disease. A harmful disorder or an adaptive, beneficial response? CMAJ 2008;179:333.
Spivak JL. Recombinant human erythropoietin and the anemia of cancer. Blood 1994;84:997.
Pincus T, Olsen NJ, Russell IJ, et al. Multicenter study of recombinant human erythropoietin in correction of anemia in rheumatoid arthritis. Am J Med 1990;89:161-7.
Henry DH, Beall GN, Benson CA, et al. Recombinant human erythropoietin in the treatment of anemia associated with immunodeficiency virus (HIV) infection and zidovudine therapy. Ann Intern Med 1992;117:739-748.
Ludwig H, Fritz E, Leitgeb C, et al. Prediction of response to erythropoietin treatment in chronic anemia of cancer. Blood 1994;84:1056-63.
Sasu BJ, Cooke KS, Arvedson TL, et al. Antihepcidin antibody treatment modulates iron metabolism and is effective in a mouse model of inflammation-induced anemia. Blood 2010;115:3616-24.
Riecke K, ZS, Boyce M, Zollner S, et al. Single and repetead dose first-in-human study with the anti-hepcidin spiegelmer. Nox-H94. Blood 2002;120:2342.
van Eijk L, SD, Aaron J, Swinkels DW, et al. Randomized double blind placebo controlled PK/PD study on the effects of a single intravenous dose of the anti-hepcidins piegelmer Nox-H94 on serum iron during experimental human endotoxemia. Blood 2002;120:3452.
Poli M, Girelli D, Campostrini N, et al. Heparin: a potent inhibitor of hepcidin expression in vitro and in vivo. Blood 2011;117:997-1004.
Hashizume M, Uchiyama Y, Horai N, et al. Tocilizumab, a humanized anti-interleukin-6 receptor antibody, improved anemia in monkey arthritis by suppressing IL-6-induced hepcidin production. Rheumatol Int 2010;30:917-23.
van Rhee F, Fayad L, Voorhees P, et al. Siltuximab, a novel anti-interleukin-6 monoclonal antibody, for Castleman’s disease. J Clin Oncol 2010;28:3701-8.
Fatih N, Camberlein E, Island ML, et al. Natural and synthetic STAT3 inhibitors reduce hepcidin expression in differentiated mouse hepatocytes expressing the active phosphorylated STAT3 form. J Mol Med (Berl) 2010;88:477-86.
Chabner BA, Amrein PC, Druker BJ, Michaelson MD, Mitsiades CS, Goss PE, Ramachandra S, Ryan DP, Richardson PG, Supko JG, Wilson WH. Fármacos antineoplásicos. Talidomida. En: Goodman & Gilman. Las bases farmacológicas de la terapéutica. 11a ed. McGraw-Hill, 2008;1369-1371.
Hideshima T, Chauhan D, Shima Y, et al. Thalidomide and its analogs overcome drug resistance of human multiple myeloma cells to conventional therapy. Blood 2000;96:2943-2950.
Mitsiades N, Mitsiades CS, Poulaky V, et al. Apoptotic signaling induced by immunomodulatory thalidomide analogs in human multiple myeloma cells: therapeutic implications. Blood 2002a;99:4525-4530.
D´Amato RJ, Loughnan MS, Flynn E and Folkman J. Thalidomide is an inhibitor of angiogenesis. Proc Natl Acad Sci USA 1994;91:4082-4085.
Davies FE, Raje N, Hidhesima T, et al. Thalidomide and immunomodulatory derivatives augment natural killer cell cytotoxicity in multiple myeloma. Blood 2001;98:210-216.
Ritcharson P, Schlossman R, Jagannath S, et al. Thalidomide for patients with relapsed multiple myeloma after high dose chemotherapy and stem cell transplantation: result of an open-label multicenter phase 2 study of efficacy, toxicity and biological activity. Mayo Clin Proc 2004;79:875-882.
Weiss G. Iron and immunity: a double edged sword. Eur J Clin Invest 2002;32: Suppl 1:70-8.
Laflash AH, Ramesh B, Simpson RJ, et al. Effects of hepcidin on intestinal iron absorption in mice. Blood 2004;103:3940-4.
Weinberg ED. Iron loading and disease surveillance. Emerg Infect Dis 1999;5:346-52.
Kaltwasser JP, Kessler U, Gottshalk R, Stucki G, Moller B. Effects of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol 2001;28:2430-6.
Weiss G, Meusburger E, Radacher G, Garimorth K, Neyer U, Mayer G. Effects of iron treatment on circulating cytokine levels in ESRD patients receiving recombinant human erythropoietin. Kidney Int 2003;64:572-8.
Goodnough LT, Skikne B, Brugnara C. Erithropoietin, iron, and erythropoiesis. Blood 2000;96:823-33.
Kaltwasser JP, Kessler U, Gottshalk R, Stucki G, Moller B. Effects of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol 2001;28:24-6.
Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absortion from daily or twice-daily doses in iron-depleted young women. Blood 2015;126:1981-9.
Stoffel UN, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol 2017;4:e524-33.