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PubMed1984

Hemoglobin levels in a Himalayan high altitude population.

This report presents data on hemoglobin concentrations in a sample of Himalayan high altitude natives measured at their habitual altitude of residence. In this sample of 270 healthy Tibetan adults resident at 3250-3560 m in Upper Chumik , Nepal, the mean hemoglobin concentration is 16.1 +/- 1.2 gm/dl among adult males, 14.4 +/- 1.4 gm/dl among premenopausal and 15.0 +/- 1.1 gm/dl among postmenopausal adult females. 123 of 126 (98%) males, 96 of 100 (96%) premenopausal and 36 of 44 (82%) postmenopausal females have hemoglobin concentrations within two standard deviations of the sea level mean. These data demonstrate that a healthy population may reside at high altitude without the degree of elevation in hemoglobin widely known and cited for Andean highlanders. Comparing published data on mean hemoglobin concentrations of adult Himalayan and Andean samples residing between 3200 m and 4100 m reveals that Himalayan means are systematically lower. This in turn may account for the reported population differences in the prevalence of chronic mountain sickness ( Monge 's disease). It is hypothesized that Himalayan and Andean highlanders represent alternative patterns of high altitude hematological adaptation.

Adaptation, Physiological↗
PubMed2006

Immunohistochemical detection of osteopontin in advanced head-and-neck cancer: prognostic role and correlation with oxygen electrode measurements, hypoxia-inducible-factor-1alpha-related markers, and hemoglobin levels.

PURPOSE: The tumor-associated glycoprotein osteopontin (OPN) is discussed as a plasma marker of tumor hypoxia. However, the association of immunohistochemical OPN expression in tumor sections with tumor oxygenation parameters (HF5, median pO(2)), the hypoxia-related markers hypoxia-inducible factor-1alpha (HIF-1alpha) and carbonic anhydrase IX (CAIX), or hemoglobin and systemic vascular endothelial growth factor (VEGF) levels has not been investigated. METHODS AND MATERIALS: Tumor tissue sections of 34 patients with advanced head-and-neck cancer treated with radiotherapy were assessed by immunochemistry for the expression of OPN, HIF-1alpha, and CA IX. Relationship of OPN expression with tumor oxygenation parameters (HF5, median pO(2)), HIF-1alpha and CA IX expression, hemoglobin and serum VEGF level, and clinical parameters was studied. RESULTS: Bivariate analysis showed a significant correlation of positive OPN staining with low hemoglobin level (p = 0.02), high HIF-1alpha expression (p = 0.02), and high serum vascular endothelial growth factor level (p = 0.02) for advanced head-and-neck cancer. Furthermore, considering the 31 Stage IV patients, the median pO(2) correlated significantly with the OPN expression (p = 0.02). OPN expression alone had only a small impact on prognosis. However, in a univariate Cox proportional hazard regression model, the expression of either OPN or HIF-1alpha or CA IX was associated with a 4.1-fold increased risk of death (p = 0.02) compared with negativity of all three markers. CONCLUSION: Osteopontin expression detected immunohistochemically is associated with oxygenation parameters in advanced head-and-neck cancer. When the results of OPN, HIF-1alpha, and CA IX immunohistochemistry are combined into a hypoxic profile, a strong and statistically significant impact on overall survival is found.

Adult↗
PubMed2006

An induction dose of epoetin alpha of 40 000 IU daily for three consecutive days increases and maintains hemoglobin levels in anemic cancer patients undergoing chemotherapy.

BACKGROUND: This pilot study was conducted to evaluate the feasibility, activity, and safety of an induction dose of epoetin alpha in cancer patients with moderate or severe anemia who were receiving chemotherapy. PATIENTS AND METHODS: Thirty patients with solid tumors and hemoglobin (Hb) levels <11.0 g/dl were enrolled. Patients received single s.c. injections of epoetin alpha, 40 000 IU for three consecutive days, and were then observed for the following 30 days. The primary efficacy variable was the response rate (Hb increase > or=1 g/dl) at day 15. Secondary efficacy variables included the proportion of patients given blood transfusions between baseline and the end of study, the duration of response (Hb level > or=1 g/dl), and ability to maintain the planned chemotherapy dose (dose intensity). RESULTS: At day 15, 23 of 30 (77%) patients had achieved increases in Hb levels of at least 1 g/dl. The mean Hb increase in responders was 2.0 g/dl [95% confidence interval (CI) = 1.7-2.3 g/dl]. The Hb increase was 2.3 +/- 0.7 g/dl in responders with baseline Hb levels <9.5 g/dl (median Hb value), and 1.7 +/- 0.6 g/dl in those with higher Hb levels (P = 0.012). The median duration of response was 6.1 weeks (95% CI = 1.6-10.6 weeks). Hematologic parameters were not significantly changed in nonresponders. Multivariate analysis detected no significant differences in Hb increase at day 15 on the basis of age, sex, weight, baseline Hb levels, type or stage of tumor, or treatment with platinum-based chemotherapy. No serious adverse event related to epoetin alpha treatment was observed. CONCLUSIONS: We conclude that a higher initial dosing of epoetin alpha appears to be an efficient schedule for treating anemia in cancer patients undergoing chemotherapy, conferring higher response rates than those seen with standard doses. Further evaluation of these and other epoetin alpha dosage regimens is warranted.

Adult↗
PubMed2002

Association between Helicobacter felis-induced gastritis and elevated glycated hemoglobin levels in a mouse model of type 1 diabetes.

Helicobacter pylori infection has been described in association with increases in glycated hemoglobin (HbA(1c)) levels in patients with type 1 diabetes. The purpose of the present study was to use an animal model of Helicobacter infection to test, under controlled conditions, the hypothesis that infection is associated with high HbA(1c) levels. Diabetes was induced in C57BL/6 mice by administration of streptozotocin, and the mice were orally inoculated with H. felis. Six weeks after inoculation, infected mice (n=10) showed gastritis scores significantly greater (P=.01) than those of uninfected mice (n=10). HbA(1c) levels were significantly higher in infected mice with gastritis (11.6%; n=6) than in infected mice without gastritis (8.4%; n=4) or uninfected mice (7.6%; n=10). It was concluded that gastritis induced by H. felis is associated with increased HbA(1c) levels in the mouse model of streptozotocin-induced diabetes.

Animals↗
PubMed2006

The epidemiology of hemoglobin levels in patients with type 2 diabetes.

BACKGROUND: Anemia is a common finding in patients with diabetes, for whom it constitutes an additional burden. The aim of this study is to clarify the natural history of anemia in patients with type 2 diabetes and describe factors that predict a decrease in hemoglobin (Hb) levels. METHODS: A 5-year prospective cohort study was designed as a follow-up of 503 individuals with type 2 diabetes in a single diabetes clinic. In addition to standard management, a full blood count was obtained at each routine visit. No intervention was undertaken to modify Hb levels. RESULTS: At baseline, 12% of patients had anemia, and an additional 13% developed anemia during follow-up. Overall Hb levels decreased by -0.07 +/- 0.01 g/dL/y, suggesting that anemia is the end point of a process that begins more than 10 years previously with the initiation of vascular damage. The greatest decreases in Hb levels were seen in patients with macroalbuminuria, renal impairment, or established macrovascular disease at baseline (all P < 0.01). In patients with microvascular disease, decreasing Hb levels tracked with decreasing glomerular filtration rates (GFRs). Patients with an estimated GFR greater than 90 mL/min/1.73 m2 (>1.5 mL/s) or normoalbuminuria had stable Hb levels during the 5-year follow-up. In patients with anemia in our cohort who were managed conservatively, Hb levels decreased by 0.09 +/- 0.03 g/dL/y. This decrease was associated with HbA1c levels, but not renal function. CONCLUSION: This study defines the natural history of Hb levels in patients with type 2 diabetes. Early identification of anemia may be achieved by means of annual or biannual screening in high-risk groups with nephropathy, advanced age, or macrovascular disease. These data are important for developing a rational response to the prevention and management of anemia.

Adult↗
PubMed2003

The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial.

BACKGROUND: With increasing use of glucosamine-containing supplements for the treatment of osteoarthritis, there is increasing concern in the medical community about possible toxic effects. The present study was undertaken to determine whether glucosamine supplementation altered hemoglobin A1c concentrations in patients with well-controlled diabetes mellitus. OBJECTIVE: To evaluate possible effects of glucosamine supplementation on glycemic control in a selected population of patients with type 2 diabetes mellitus. DESIGN: Placebo-controlled, double-blinded, randomized clinical trial. SETTING: Outpatient, diabetes monitoring clinic. PATIENTS: Patients were typically elderly patients, evenly divided between men and women. Most of the patients were being treated with 1 or 2 drugs for glycemic control. INTERVENTION: In daily doses for 90 days, patients received either placebo or a combination of 1500 mg of glucosamine hydrochloride with 1200 mg of chondroitin sulfate (Cosamin DS; Nutramax Laboratories Inc, Edgewood, Md). Main Outcome Measure Hemoglobin A1c levels before and after 90 days of therapy. RESULTS: There were 4 withdrawals from the glucosamine-treated group. Three were related to comorbidities (myocardial infarction, congestive heart failure, and atrial fibrillation) and 1 to a possible adverse reaction (excessive flatus). No other patient reported any adverse effects of glucosamine therapy, and no patient had any change in their diabetes management. Mean hemoglobin A1c concentrations were not significantly different between groups prior to glucosamine therapy. Posttreatment hemoglobin A1c concentrations were not significantly different between groups, nor were there any significant differences within groups before and after treatment. CONCLUSION: This study demonstrates that oral glucosamine supplementation does not result in clinically significant alterations in glucose metabolism in patients with type 2 diabetes mellitus.

Aged↗
PubMed2002

Hemoglobin levels, cardiovascular disease, and left ventricular hypertrophy in patients with chronic kidney disease. Case study of the anemic patient.

Cardiovascular disease is the primary cause of morbidity and mortality in patients with chronic kidney disease. Anemia, a well-defined risk factor for cardiovascular disease, has been shown to contribute to the development of angina pectoris, ischemic events, and left ventricular hypertrophy. Data indicate that these cardiovascular-related disorders are often ameliorated or reversed in patients who maintain hemoglobin (Hb) levels in the 11 to 12 g/dL range recommended by NKF-K/DOQI. Conversely, Hb levels below 11 g/dL result in an increase in cardiovascular disorders and a 2.9-fold increased risk of death. Nephrology nurses should understand the interplay between Hb levels and cardiovascular disease, and how their efforts to maintain Hb levels > or = 11 g/dL can positively affect patient outcomes.

Anemia↗
PubMed1989

[Influence of hemoglobin level, arterial oxygen partial pressure and arterial oxygen content on the results of radiation therapy in lung squamous cell cancer].

It is believed that anemia is an important prognostic factor in the case of cancer patients treated by radiation therapy. One possible explanation for this is tumor oxygenation. With respect to tumor oxygenation, the arterial oxygen content (CaO2) may be more direct indicator than hemoglobin (Hb) level. Fourty-two patients with squamous cell lung cancer treated solely by irradiation were reviewed. It was found that CaO2 was more important than the Hb level in determining a tumor response to radiation therapy. This is considered as important indirect evidence of the existence of hypoxic fractions of cells in human tumors.

Adult↗
PubMed2005

Standard of care for cancer-related anemia: improving hemoglobin levels and quality of life.

The introduction of recombinant human erythropoietin (rHuEPO) has proven to be a major advance in the therapeutic options available for managing anemia in cancer patients. The results of placebo-controlled clinical trials and large, community-based, open-label studies have confirmed that epoetin alfa, a recombinant human erythropoietin, significantly reduces transfusion requirements, and reliably increases hemoglobin (Hb) levels in anemic (Hb level <12 g/dl) cancer patients undergoing chemotherapy. Increased Hb improves patients' energy level and their ability to perform the activities of daily living, as well as their overall quality of life (QOL). These findings are independent of tumor type and disease status and are comparable in patients receiving nonplatinum- and platinum-based chemotherapeutic regimens. Furthermore, more than a decade of use in clinical trials and by physicians in routine clinical practice has demonstrated that epoetin alfa is safe and well tolerated when used to treat cancer patients with anemia. The availability of epoetin alfa as an alternative to transfusion has changed practices in anemia management; physicians can now treat anemia with the goal of achieving adequate Hb levels to relieve anemia-related fatigue, a major symptom contributing to decreased QOL in cancer patients. Incremental benefit analysis has shown that increasing Hb level from 11 g/dl to 12 g/dl yields the greatest improvement in QOL per 1 g/dl increase in Hb. The demonstrated efficacy of epoetin alfa for increasing Hb levels and improving patient QOL have made this agent a rationale choice for management of cancer-related anemia. Ongoing research will continue to provide new insights into best management of anemia with epoetin alfa in cancer patients.

Anemia, Hypochromic↗
PubMedDate not supplied

Gender differences in glycosylated hemoglobin levels in seasonal affective disorder patients and controls.

Seasonal affective disorder (SAD) has been shown to manifest different symptoms in female and male patients. Specifically, women with SAD have been shown to have greater increases in overeating, weight gain, and increased sleep as compared with their male counterparts. Given these dietary changes, we predicted that female SAD patients would exhibit increased glycosylated hemoglobin (HbA1) levels, indicative of chronically elevated glucose levels. Twenty-two patients (15 women and seven men) and matched controls were enrolled during the winter season and tested for HbA1 levels. A three-way analysis of variance (ANOVA; gender x group x season) was insignificant and the result was a negative study. After the initial hypothesis was rejected, we undertook a post-hoc analysis of the data, from which emerged that in winter, women patients had higher HbA1 levels as compared with matched controls. As our original hypothesis was rejected, we cannot accept the results of the post-hoc study. However, numerous other studies have demonstrated that female and male SAD patients differ in their pathophysiology, and are suggestive that in future analyses ought to consider analyzing subjects separately across gender.

Adult↗
PubMedDate not supplied

Hemoglobin levels and anemia-associated symptoms in pregnant Liberian women.

An epidemiological study was conducted of 515 pregnant Liberian women. The purposes of the study were to 1) assess the prevalence of anemia in Liberian women during the last trimester of pregnancy (when latent deficiencies are more apt to become clinically manifest), 2) ascertain which physician-obtained symptoms are related to low hemoglobin (Hb) levels and anemia, and 3) determine the sensitivity and specificity of symptoms commonly associated with anemia. The results indicated that the prevalence of anemia (defined as Hb < 11.0 g/dl) was 79.8%. Women who had headache as a symptom had significantly lower mean Hb values than women who did not have this symptom. The socioeconomic status of women with and without symptoms was not statistically different. The sensitivity of headache as an indicator of anemia and low Hb values was 83%, but the specificity of this symptom was low (27%). The utility of signs and symptoms as indicators is discussed in relation to the economic means of lesser-developed societies and their cultural practices.

Adolescent↗
PubMed2001

Impact of hemoglobin levels before and during concurrent chemoradiotherapy on the response of treatment in patients with cervical carcinoma: preliminary results.

BACKGROUND: In patients undergoing radiation for cervical carcinoma, there is evidence that anemia is associated with an impaired outcome. For patients undergoing chemoradiation, there are no data available. The objective of this retrospective study was to examine the impact of anemia before and during chemoradiation in patients with cervical carcinoma. METHODS: The authors collected data on hemoglobin (Hb) levels before and during treatment from 57 patients with cervical carcinoma. The stage of disease ranged between Stage IB and Stage IVA. All patients were treated with concurrent chemoradiation. Response to chemoradiation was evaluated by univariate and multivariate analyses. RESULTS: The mean Hb level at the time of presentation was 12.9 +/- 1.6 g/dL in patients with a complete clinical response (CCR) and 12.1 +/- 1.4 g/dL in those with persistent disease (P = 0.126). In patients with a CCR, the mean nadir Hb level was 11.1 +/- 1.3 g/dL, and in patients with treatment failure, it was 9.8 +/- 1.8 g/dL (P = 0.008). A univariate logistic regression model demonstrated that the nadir Hb level was the most predictive factor for treatment failure (relative risk, 1.92; P = 0.015) followed by disease stage (relative risk, 0.51; P = 0.074). In a multivariate model, the nadir Hb level remained the only prognostically relevant factor predicting the response to chemoradiation. Only patients with nadir Hb values > 11 g/dL throughout chemoradiation had a more than 90% chance of achieving a CCR. CONCLUSIONS: In patients undergoing chemoradiation for cervical carcinoma, the nadir Hb level is highly predictive of response to treatment, whereas the Hb level at the time of presentation is prognostically not significant.

Adult↗
PubMed2001

Clinical experience with epoetin alfa in the management of hemoglobin levels in orthopedic surgery and cancer. Implications for use in gynecologic surgery.

Recombinant human erythropoietin (r-HuEPO, epoetin alfa) is used for treatment of anemia associated with chemotherapy for non-myeloid malignancies, chronic renal failure and zidovudine treatment in patients infected with the human immunodeficiency virus and for anemic patients undergoing elective, noncardiac, nonvascular surgery. Epoetin alfa has been shown to safely increase preoperative hemoglobin (Hb) levels in anemic patients undergoing elective noncardiac, nonvascular surgery and is more effective than preoperative autologous blood donation in reducing the need for perioperative blood transfusions in orthopedic surgery patients. Epoetin alfa was shown to significantly increase Hb levels and decrease transfusion requirements in gynecologic cancer patients undergoing chemotherapy. A once-weekly regimen of 40,000 IU per dose was effective in these patients. In addition to decreasing transfusion requirements and increasing Hb, epoetin alfa for relieving anemia-related fatigue and improving quality of life was demonstrated in clinical trials in anemic cancer patients receiving chemotherapy. With regard to quality of life in orthopedic surgery patients, a novel instrument to measure the effect of Hb management on postoperative recuperative power (i.e., vigor, functional ability) has been validated and may prove to be useful in optimizing rehabilitation and discharge planning. Extensive clinical experience with epoetin alfa in anemic patients undergoing major elective orthopedic surgery or those with gynecologic cancer provides a strong basis for its use in gynecologic surgery.

Anemia↗
PubMed2005

The association of increased total glycosylated hemoglobin levels with delayed age at menarche in young women with type 1 diabetes.

CONTEXT: Delayed menarche is associated with subsequent reproductive and skeletal complications. Previous research has found delayed growth and pubertal maturation with type 1 diabetes and poor glycemic control. The effect of diabetes management on menarche is important to clarify, because tighter control might prevent these complications. OBJECTIVE: The objective of this study was to investigate age at menarche in young women with type 1 diabetes and examine the effect of diabetes management [e.g. total glycosylated hemoglobin (GHb) level, number of blood glucose checks, insulin therapy intensity, and insulin dose] on age at menarche in those diagnosed before menarche. DESIGN: The Wisconsin Diabetes Registry Project is a follow-up study of a type 1 diabetes population-based incident cohort initially enrolled between 1987 and 1992. SETTING: This study was performed in 28 counties in south-central Wisconsin. PATIENTS OR OTHER PARTICIPANTS: The study participants were recruited through referrals, self-report, and hospital/clinic ascertainment. Individuals with newly diagnosed type 1 diabetes, less than 30 yr old, were invited to participate. Of 288 young women enrolled, 188 reported menarche by 2002; 105 were diagnosed before menarche. INTERVENTIONS: There were no interventions. MAIN OUTCOME MEASURE: The main outcome measure was age at menarche. RESULTS: Mean age at menarche was 12.78 yr, compared with 12.54 yr in the United States (P = 0.01). Ages at menarche and diagnosis were not associated. For those diagnosed before menarche, age at menarche was delayed 1.3 months with each 1% increase in mean total GHb level in the 3 yr before menarche. CONCLUSIONS: Age at menarche was moderately delayed in young women with type 1 diabetes. Delayed menarche could potentially be minimized with improved GHb levels.

Adolescent↗
PubMed1999

The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix.

BACKGROUND: It is unclear whether blood transfusion can overcome the negative impact of anemia before or during radiotherapy (RT) in patients with carcinoma of the cervix. The objective of this retrospective study was to examine the impact of anemia and blood transfusion on 605 patients with carcinoma of the cervix treated with radical RT at 7 centers across Canada in 1989, 1990, and 1992. METHODS: The data collected included hemoglobin (Hgb) levels from the time of diagnosis to the end of therapy; blood transfusions administered; and identifiable patient-, tumor-, and treatment-related factors. Survival, disease free survival, and pelvic control analyses were evaluated by univariate and multivariate analysis. RESULTS: The median follow-up was 41 months (range, 0-92 months). Presenting Hgb level, average weekly nadir Hgb (AWNH) during RT, and blood transfusion were correlated significantly with local control, disease free survival, and overall survival on univariate analysis. However, the AWNH remained significant on multivariate analysis, whereas Hgb at presentation and blood transfusion did not. The 5-year survival was 74% for patients with an AWNH >/= 120 g/L, 52% for patients with AWNH levels 110-119 g/L inclusive, and 45% for patients with AWNH levels < 110 g/L (P < 0.0001). At each Hgb level, patients who were transfused and maintained a specific Hgb level had a survival rate that was not significantly different from patients who were at that level spontaneously. There was a significant reduction in both pelvic and distant recurrence (P < 0.0001 and P < 0.0006, respectively) in patients whose AWNH level during RT was >/= 120 g/L compared with < 120 g/L. A reduction in the rate of distant recurrence was observed in patients with and without pelvic recurrence. CONCLUSIONS: AWNH is highly predictive of outcome for patients treated with RT for carcinoma of the cervix. Blood transfusion appears to overcome the negative prognostic effects of low presenting Hgb levels and AWNH levels.

Adenocarcinoma↗
PubMed2006

Negative association of obesity and its related chronic inflammation with serum glycated albumin but not glycated hemoglobin levels.

BACKGROUND: Measurements of glycated albumin (GA) as well as glycated hemoglobin (HbA1c) have been applied in order to monitor chronic glycemic control in diabetic patients. Both glycated proteins are known influenced by various factors other than glycemia. It has recently been reported that GA level is low in obese, non-diabetic children and is negatively associated with body mass index (BMI) in adult diabetic patients. However, the reasons for the connection between obesity and GA remain unknown. The aim of this study was to examine whether BMI and the obesity-related inflammatory marker plasma high-sensitivity C-reactive protein (hs-CRP) are independently associated with GA and HbA1c. METHODS: Two hundred and twelve non-diabetic subjects (158 with normal glucose tolerance and 54 with impaired glucose tolerance) were enrolled in this study. The effects of fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) 2-h glucose, age, BMI and hs-CRP on HbA1c as well as those on GA were analyzed. RESULTS: FPG significantly correlated with HbA1c, and also significantly but weakly correlated with GA. BMI showed a significantly positive correlation with HbA1c, whereas it negatively correlated with GA. Plasma hs-CRP showed a weak positive correlation with HbA1c, whereas it was negatively associated with GA. By stepwise multivariate regression analyses, BMI and hs-CRP were negatively associated with GA but not with HbA1c. CONCLUSIONS: These results demonstrated that BMI as well as hs-CRP were independent negative risks of GA but not of HbA1c in non-diabetic subjects. Obesity and its related chronic inflammation are involved in lower serum GA levels, but not HbA1c levels, in relation to glycemia.

Body Mass Index↗
PubMed2002

Association of maternal blood pressure and hemoglobin level with organochlorines in human milk.

Milk samples of women from the general population in Lucknow were analysed by gas-liquid chromatography to determine the concentration of organochlorine pesticides and their possible association with maternal characteristics. p,p'-DDT (dichloro diphenyltrichloroethane), p,p-DDE (dichloro diphenyltrichloroethylene), p,p'-DDD (dichloro diphenyl dichloroethane), alpha, beta gamma and delta isomers of hexachlorocyclohexane (HCH) and aldrin were detected. The calculated daily intake of DDT and HCH by the neonates exceeded their acceptable daily intake (ADI) set by the WHO. A statistically significant association was noted between alpha-HCH residues in milk and hemoglobin (Hb) level in maternal blood (P < 0.001). Also, there was a significant association between gamma-HCH and p,p'-DDT levels in milk and diastolic blood pressure of mother (P < 0.05). An apparent negative relationship between p,p'-DDE level in mother's milk and birthweight of the baby was also noticed (P < 0.05). These results highlight the need for periodic monitoring to determine organochlorine contamination in human milk and assess their impact on mother and on neonatal health.

Birth Weight↗
PubMed2006

Impact of hemoglobin levels on outcomes of adjuvant chemotherapy in resected non-small cell lung cancer: the JBR.10 trial experience.

BACKGROUND: Cisplatin-induced anemia may correlate with adverse events, poor quality of life (QoL), decreased adjuvant chemotherapy (ACT) dose intensity, shorter relapse-free survival (RFS) or overall survival (OS). METHODS: The JBR.10 trial demonstrated significantly longer survival with adjuvant cisplatin and vinorelbine (n=242) compared to observation (n=240) in patients with resected NSCLC [Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 2005;352(25):2640-2]. This exploratory analysis evaluates the predictive value of baseline (in all patients) and during-treatment (in ACT arm only) hemoglobin (Hb) levels on OS and RFS when adjusted for prognostic factors. Baseline (in all patients) and during treatment (in ACT arm only) Hb levels were also correlated with adverse events, QoL, morbidity and ACT dose intensity. RESULTS: Baseline Hb did not predict RFS or OS. However, there was a trend to shorter OS (p=0.1) when baseline Hb was <120g/L. Lower baseline Hb predicted increased hospitalization (p=0.04) and worse QoL (SOB item, p=0.03) but had no impact on adverse events or dose intensity. There was a trend to longer RFS (p=0.08) in patients with lower nadir during-treatment Hb and to longer OS (p=0.06) and RFS (p=0.08) in patients with maximum during-treatment Hb drop >30% that was not maintained when ACT dose intensity was included in the model. Maximum during-treatment Hb drop >30% correlated with increased lethargy (p=0.003) and worse QoL (fatigue item, p=0.07). CONCLUSIONS: Lower baseline and during-treatment Hb levels seem associated with poorer QoL, fatigue and increased hospitalization. There is a trend for shorter OS in patients with lower baseline Hb levels.

Anemia↗