Intravenous Iron as an Alternative to Blood Transfusion in Cancer Patients: A Single Center Experience

Background: Anemia is common in cancer patients receiving palliative care, causing significant symptom burden and transfusion requirement. While intravenous (IV) iron is recognized for its role in chemotherapy-induced anemia, its efficacy in broader palliative oncology settings is underexplored. Our study provides real-world experience with IV iron in cancer patients, particularly those receiving supportive care alone. Methods: This retrospective study was conducted at an integrated oncology center in Hong Kong from January 2019 to August 2023. Patients who received IV iron were evaluated for changes in hemoglobin (Hb) and transfusion requirements. Results: Among 283 eligible episodes, mean Hb increased from 7.6 g/dL at baseline to 8.8 g/dL and 9.3 g/dL by days 28 and 60, respectively (ps < 0.001). Mean units of packed cells transfused per patient declined by 55% within to 12 weeks following IV iron (P = 0.01). Among 164 (58%) patients receiving supportive care alone, Hb rose from 7.3 g/dL to 8.3 g/dL on day 28 (P < 0.001), with a 62% reduction in transfusions (P = 0.04). Adverse reactions were observed in 4 patients (1.1%), none with significant consequences. Baseline Hb, treatment intent and iron deficiency group significantly predicted Hb change on day 28 in multiple linear regression. Conclusion: IV iron significantly improved anemia and reduced transfusion requirements in cancer patients with anemia, including those receiving supportive care. To our knowledge, this study presents the largest dataset on IV iron use in cancer patients receiving supportive care to date. Future studies should explore its effect on symptoms management, quality of life and health-economic benefits.