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Studie

Therapieinduzierte Anämie - Diagnostik und Therapie bei soliden Tumoren und malignen Lymphomen, Qualitätssicherung Anämie (AIO-SUP-0121).
Repräsentative, retrospektive, epidemiologische Registerstudie, gemeinsame Studie der Arbeitsgemeinschaften Internistische Onkologie (AIO), AG Supportivtherapie und Supportive Maßnahmen in der Onkologie (AGSMO) in der DKG,
Sponsor: AIO-Studien gGmbH
Publikation des Studiedesigns:
Link, H., Kerkmann, M., & Holtmann, L. (2021). Anämie – Diagnostik und Therapie bei soliden Tumoren und malignen Lymphomen. Forum, 36(4), 326-327. doi:10.1007/s12312-021-00948-7

Die Studie ist abgeschlossen und ausgewertet, folgende wichtige Ergebnisse wurden erzielt (DGHO 2022 Abstract):

Quality Assurance Initiative on Anemia Management in Patients with Solid Tumors and Hematologic Neoplasms
Hartmut Link, Prof. Dr., Markus Kerkmann, MA, Laura Holtmann, MSc
Arbeitsgemeinschaften Internistische Onkologie (AIO) und Supportive Maßnahmen in der Onkologie (AGSMO) in der Deutschen Krebsgesellschaft (DKG) – AIO-SUP-0121

Introduction

Anemia is a frequent complication in patients with breast cancer (BC), gastrointestinal tumors (GC), lung cancer (LC) and malignant lymphomas (ML). Guidelines (GL) on anemia management (ESMO; DGHO) provide dedicated algorithms for diagnosis and treatment of anemia. Aim of the study was to analyze GL adherence (GLAD) in Germany.

Methods: This was a retrospective sample analysis representative for practices and hospitals in Germany. Data on tumor treatments and anemia management was collected from records of cancer patients (pts) with grade ≥ 2 anemia diagnosed between January and June 2021.

Definition of diagnosis GLAD score (GLAD-D): 2 points (pt) for full adherence, 1 pt for a lack in differential diagnosis on iron metabolism. 0 pt if differential diagnosis is missing. Treatment GLAD score (GLAD-T): 2 pt for full adherence to GL recommendation in relation to diagnosis. 1 pt for indicated red blood cells (RBC) as only anemia therapy or no therapy in pts with Hb ≥8g/dl. 0 pt for RBC without indication, p.o. iron substitution under inflammatory conditions (CRP>5mg/l) or vitamin B12 or folate deficiency without substitution.

Results: Data from 1046 pts (311 BC, 371 GC, 260 LC, 104 ML) were collected from 143 centers. 996 (92.4%) pts were treated with medical tumor therapy and 317 (30.3%) received radiotherapy. Hb-values at diagnosis of anemia were 8-10 g/dl in 899 (85.9%) pts, 6-8g/dl in 135 (12.9%) and <6g/dl (1.2%) in 12 pts. 456 pts were treated with RBC (43.6%), 198 (18.9%) with iron substitution, 106 (10.1%) with ESA and 60 (5.7%) with vitamin B12. 60.6% of the pts with iron substitution were treated i.v. and 39.4% p.o. 37.5% of pts with RBC had no indication in the sense of the restrictive RBC policy recommended by the GLs.

GLAD was poor in diagnosis and treatment: GLAD-D was 2 pt in 310 pts (29.6%) of pts, 1 pt at 168 (16.1%) and 0 pt in 568 (54.3%) pts. GLAD-T was 2 pt in 270 pts (25.8%), 1 pt in 310 (29.6%) and 0 pt in 466 (44.6%).

Higher GLAD-D correlated significantly to a higher GLAD-T (τB 0.262, p<0.001). Full GLAD-T (2 pt) was significantly associated with a greater Hb increase than GLAD-T 0/1 (p<0.001) at 28 days (10.2 vs. 9.7 g/dl) and at 2 months (10.4 vs 9.9 g/dl).

Conclusions Pts with anemia management as per GL had a significantly stronger Hb-increase. GLAD is poor in Germany, especially concerning the too liberal transfusion policy and the lack of differential diagnostics of iron metabolism.

NCT05190263, Grant: Pharmacosmos

Leitlinie Supportivtherapie

Die Leitlinie wird derzeit unter intensiver Mitarbeit vieler AIO-Mitglieder aktualisiert. Es finden am 22.11.22 und 17.1.2023 online Leitlinienkonferenzen statt, um die aktualisierten und neuen Empfehlungen abzustimmen, die zur durch zahlreiche Arbeitsgruppen erstellt wurden. Leitlinienkoordination: Prof. Dr. Karin Jordan, Potsdam, Dr. Franziska Jahn, Universitätsklinikum Halle https://s3supportiv.de/

Publikationen

Link H, Kerkmann M, Holtmann L. Immunoglobulin substitution in patients with secondary antibody deficiency in chronic lymphocytic leukemia and multiple myeloma: a representative analysis of guideline adherence and infections. Support Care Cancer. 2022;30(6):5187-200.
PMID: 35257229 PMCID: PMC9046374 DOI: 10.1007/s00520-022-06920-y

Abstracts

Link, M. Kerkmann, L. Holtmann ESMO Kongress 2022 Paris, Poster und ePoster, Abstract 1593P - Real-world data on anemia management in patients with solid tumors and malignant lymphoma in Germany https://oncologypro.esmo.org/meeting-resources/esmo-congress/real-world-data-on-anemia-management-in-patients-with-solid-tumors-and-malignant-lymphoma-in-germany

DGHO Kongress 2022 Wien, Vortrag, Abstract Qualitätssicherung zum Anämiemanagement bei Patientinnen und Patienten mit soliden Tumoren und hämatologischen Neoplasien. https://www.karger.com/Article/Pdf/526456, Seite 251