Iron Management in ESRD Patients with Multiple Myeloma

Introduction to Iron Supplementation

• The European Myeloma Network recommends intravenous iron supplementation for multiple myeloma patients with iron deficiency, particularly when using erythropoiesis-stimulating agents (ESAs), with a grade 1A recommendation 1, 2, 3

Assessment and Monitoring

• Measure serum ferritin, transferrin saturation (TSAT), and hemoglobin levels before initiating therapy, and define iron deficiency as ferritin <100 ng/mL or TSAT <20% with normal ferritin 5
• Monitor hemoglobin and iron parameters (ferritin, TSAT) before each chemotherapy cycle if the patient is receiving myeloma treatment, and maintain target hemoglobin levels with minimum treatment necessary 5

Administration and Dosing

• Administer IV iron sucrose if hemoglobin is 8-10 g/dL with documented iron deficiency, or if the patient is receiving or planning to receive ESA therapy, with standard dosing of 1000 mg total dose 1, 2, 3, 5
• For ESRD patients, consider IV iron sucrose if ferritin <200 ng/mL and TSAT <20%, as recommended by the American Academy of Sleep Medicine 4

Safety Considerations

• Do not allow hemoglobin to exceed 12 g/dL when using ESAs concurrently, as recommended by the European Myeloma Network 1, 2, 3
• The thrombotic risk associated with ESA use is not a contraindication to IV iron use itself, according to the Annals of Oncology 5