Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia - systematic review and meta-analysis of randomised controlled trials

Acta Oncol. 2013 Jan;52(1):18-29. doi: 10.3109/0284186X.2012.702921. Epub 2012 Aug 9.


Background: Current guidelines are inconclusive regarding intravenous (IV) iron for treatment of chemotherapy-induced anaemia (CIA).

Material and methods: Systematic review and meta-analysis of randomised controlled trials comparing IV iron with no iron or oral iron for treatment of chemotherapy induced anaemia (CIA).

Primary outcomes: haematopoietic response and red blood cell (RBC) transfusion requirements. For dichotomous data, relative risks (RR) with 95% confidence intervals (CIs) were estimated and pooled. For continuous data, weighted mean differences were calculated.

Results: Eleven trials included 1681 patients, the majority examining the addition of IV iron to erythropoiesis stimulating agents (ESA) (1562 patients, 92.9%). IV iron significantly increased haematopoietic response rate [RR 1.28 (95% CI 1.125-1.45), seven trials with ESA] and decreased the rate of blood transfusions both in trials with ESA [RR 0.76 (95% CI 0.61-0.95), seven trials] and without ESA [RR 0.52 (95% CI 0.34-0.80)]. The increase in haematopoietic response rate correlated with total IV iron dose, regardless of baseline iron status. Mortality and safety profile was comparable between groups.

Conclusions: IV iron added to ESA results in an increase in haematopoietic response and reduction in the need for RBC transfusions, with no difference in mortality or adverse events.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anemia, Iron-Deficiency / drug therapy*
  • Anemia, Iron-Deficiency / etiology
  • Antineoplastic Agents / adverse effects*
  • Blood Transfusion
  • Drug Therapy, Combination
  • Hematinics / therapeutic use*
  • Hematopoiesis
  • Humans
  • Infusions, Intravenous
  • Iron Compounds / therapeutic use*
  • Neoplasms / drug therapy
  • Quality of Life
  • Randomized Controlled Trials as Topic


  • Antineoplastic Agents
  • Hematinics
  • Iron Compounds