Early and late hyperferremia during cisplatin chemotherapy

Area of Science:

• Oncology
• Hematology
• Pharmacology

Background:

• Chemotherapy, particularly high-dose cisplatin, is a cornerstone in cancer treatment.
• Understanding drug-induced metabolic changes is crucial for patient management and safety.

Purpose of the Study:

• To investigate the effects of high-dose cisplatin on plasma iron levels and related parameters in cancer patients.
• To elucidate the mechanisms behind cisplatin-induced hyperferremia.

Main Methods:

• Plasma iron and ferritin levels were monitored in 48 cancer patients undergoing 56 courses of polychemotherapy with high-dose cisplatin.
• Hemolysis markers, red blood cell counts, hemoglobin, liver and muscle enzymes, and reticulocyte counts were assessed.

Main Results:

• Serum iron increased threefold within 24 hours post-cisplatin infusion (from 78.25 to 242.12 µg/dL), returning to baseline by day 10.
• Ferritin levels progressively increased, peaking on day 7.
• Reduced reticulocyte counts from day 3 onwards indicated impaired erythropoiesis, but could not explain the early hyperferremia.

Conclusions:

• Cisplatin induces a biphasic hyperferremia: an early phase likely due to interference with reticuloendothelial cells, and a later phase linked to reduced iron uptake by bone marrow due to impaired erythropoiesis.
• Hemolysis and tissue necrosis were ruled out as causes.