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Supportive Care in Cancer

, Volume 16, Issue 1, pp 67–74 | Cite as

Anemia during adjuvant non-taxane chemotherapy for early breast cancer: Incidence and risk factors from two trials of the International Breast Cancer Study Group

  • Lorenzo GianniEmail author
  • Bernard F. Cole
  • Ilaria Panzini
  • Raymond Snyder
  • Stig B. Holmberg
  • Michael Byrne
  • Diana Crivellari
  • Marco Colleoni
  • Stefan Aebi
  • Edda Simoncini
  • Olivia Pagani
  • Monica Castiglione-Gertsch
  • Karen N. Price
  • Aron Goldhirsch
  • Alan S. Coates
  • Alberto Ravaioli
Original Article

Abstract

Goal of the work

Anemia is a common side effect of chemotherapy. Limited information exists about its incidence and risk factors. The objective of this study was to evaluate the incidence of anemia and risk factors for anemia occurrence in patients with early breast cancer who received adjuvant chemotherapy.

Materials and methods

We evaluated risk factors for anemia in pre- and post/perimenopausal patients with lymph node-positive early breast cancer treated with adjuvant chemotherapy in two randomized trials. All patients received four cycles of doxorubicin and cyclophosphamide (AC) followed by three cycles of cyclophosphamide, methotrexate, fluorouracil (CMF). Anemia incidence was related to baseline risk factors. Multivariable analysis used logistic and Cox regression.

Main results

Among the 2,215 available patients, anemia was recorded in 11% during adjuvant chemotherapy. Grade 2 and 3 anemia occurred in 4 and 1% of patients, respectively. Pretreatment hemoglobin and white blood cells (WBC) were significant predictors of anemia. Adjusted odds ratios (logistic regression) comparing highest versus lowest quartiles were 0.18 (P < 0.0001) for hemoglobin and 0.52 (P = 0.0045) for WBC. Age, surgery type, platelets, body mass index, and length of time from surgery to chemotherapy were not significant predictors. Cox regression results looking at time to anemia were similar.

Conclusions

Moderate or severe anemia is rare among patients treated with AC followed by CMF. Low baseline hemoglobin and WBC are associated with a higher risk of anemia.

Keywords

Adjuvant therapy Adverse event Anemia Breast cancer Chemotherapy 

Notes

Acknowledgment

We thank the patients, physicians, nurses, data managers, and trial coordinators who participate in the International Breast Cancer Study Group trials and Joie Celano for central data management. Supported in part by the Swiss Group for Clinical Cancer Research, Frontier Science and Technology Research Foundation, The Cancer Council Australia, Australian New Zealand Breast Cancer Trials Group, National Health and Medical Research Council of Australia (grants 940892, 980380, 100925), United States National Cancer Institute (CA-75362), Swedish Cancer Society, Foundation for Clinical Research of Eastern Switzerland, Cancer Association of South Africa (for South African patients), Orion-Farmos (for medication for trial 14–93).

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Lorenzo Gianni
    • 1
    Email author
  • Bernard F. Cole
    • 2
    • 3
  • Ilaria Panzini
    • 1
  • Raymond Snyder
    • 4
  • Stig B. Holmberg
    • 5
  • Michael Byrne
    • 6
  • Diana Crivellari
    • 7
  • Marco Colleoni
    • 8
  • Stefan Aebi
    • 9
    • 10
  • Edda Simoncini
    • 11
  • Olivia Pagani
    • 10
    • 12
  • Monica Castiglione-Gertsch
    • 13
  • Karen N. Price
    • 14
  • Aron Goldhirsch
    • 8
    • 12
  • Alan S. Coates
    • 13
    • 15
  • Alberto Ravaioli
    • 1
  1. 1.Divisione di Oncologia e di EmatologiaOspedale degli Infermi, and Istituto Scientifico Romagnolo per lo Studio e la Cura dei TumoriRiminiItaly
  2. 2.IBCSG Statistical CenterBostonUSA
  3. 3.Dartmouth Medical SchoolLebanonUSA
  4. 4.St. Vincent’s Hospital MelbourneMelbourneAustralia
  5. 5.Department of SurgerySahlgrenska University HospitalGothenburgSweden
  6. 6.Sir Charles Gairdner HospitalNedlandsAustralia
  7. 7.Centro di Riferimento OncologicoAvianoItaly
  8. 8.European Institute of OncologyMilanItaly
  9. 9.InselspitalBernSwitzerland
  10. 10.Swiss Group for Clinical Cancer Research (SAKK)BernSwitzerland
  11. 11.Oncologia Medica-Spedali CiviliBresciaItaly
  12. 12.Oncology Institute of Southern SwitzerlandBellinzonaSwitzerland
  13. 13.International Breast Cancer Study Group Coordinating CenterBernSwitzerland
  14. 14.IBCSG Statistical CenterFrontier Science and Technology Research FoundationBostonUSA
  15. 15.University of SydneySydneyAustralia

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