Cancer chemotherapy induces a transient increase of serum-iron level

Twenty eight consecutive patients with advanced solid malignancies were studied for variations in serum iron level after a first course of chemotherapy. Eleven different schedules involving twelve drugs were administered. Serum-iron level and serum siderophyllin, hemogram, reticulocytes, inflammatory tests, hemolysis parameters and hepatic enzymes were evaluated before treatment and around the fourth, twelfth and twenty first day after. Response to treatment was measured in all patients. In each patient, regardless of the sex, nature of the tumor or drugs administered, a high increase of serum-iron level was observed between the third and the seventh day after the start of treatment (mean: +263%, range: 78-953%). In twenty one patients, sideremia overstepped the normal range. This variation of serum iron level was transient and the level of sideremia approached the initial rate when it was measured around the thirteenth day after the start of treatment. This phenomenon did not appear to be related to tumor lysis, hemolysis, liver cytolysis or improvement of the inflammatory syndrome. The constant observation of reduction in reticulocytes concurrent with the increase in serum-iron, suggests a mechanism involving impairment of the reticulo-endothelial cells implicated in iron metabolism, due to anticancer drugs. Among the drugs used in this study, actinomycin D, adriamycin, cyclophosphamide and 5-fluorouracil seem to be imputed in the phenomenon observed.