Cancer-Associated Anemia in Patients with β-Thalassemia Minor: Time to Rethink Current Management?

Abstract

Background: Cancer-associated anemia (CAA) is a frequent complication of systemic anticancer therapy that adversely affects quality of life, treatment adherence, and clinical outcomes. Current management recommendations are largely based on evidence from the general oncology population and do not address patients with β-thalassemia minor, an inherited hemoglobinopathy characterized by chronic microcytosis and altered erythropoiesis. This review examines whether current approaches to CAA management are fully applicable to this unique patient population.

Methods: A narrative review of the available literature was conducted, focusing on international clinical guidelines, studies evaluating erythropoiesis-stimulating agents (ESAs), transfusion strategies, and the biological mechanisms of erythropoiesis in β-thalassemia minor. Existing evidence regarding the interaction between chemotherapy, anemia, and β-thalassemia minor was critically assessed to identify current knowledge gaps and future research priorities.

Results: Current ASCO/ASH and NCCN recommendations provide no disease-specific guidance for managing CAA in patients with β-thalassemia minor. Limited clinical observations suggest that responses to chemotherapy and ESA therapy may differ from those of the general oncology population, potentially due to altered erythropoiesis, fetal hemoglobin induction, and unique erythroid biology. However, available evidence is sparse and largely derived from small observational studies or experimental models, precluding changes to current clinical practice.

Conclusions: Patients with concomitant cancer and β-thalassemia minor represent an underrecognized subgroup for whom evidence-based supportive care recommendations remain lacking. Although current data do not justify modification of existing anemia management guidelines, they highlight an important unmet need for prospective clinical studies and translational research. Addressing this evidence gap may facilitate the development of more individualized supportive care strategies and advance the concept of precision supportive oncology.