Efficacy and safety of phlebotomy to reduce transfusional iron overload in adult, long-term survivors of acute leukemia.
BACKGROUND
Transfusional iron overload is a frequent finding in long-term survivors of acute leukemia (AL). Only a few studies have reported the results of iron depletion therapy in this category of patients.


METHODS
Between January 1996 and July 2003, 26 consecutive adult patients who achieved complete remission of AL and developed transfusional iron overload underwent a weekly phlebotomy program at our transfusion center. Serum ferritin levels and transferrin saturation were monitored during the iron depletion therapy and the follow-up period. These AL patients were also checked for the presence of 12 hereditary hemochromatosis (HH) gene mutations.


RESULTS
After a mean follow-up of 57.8 months, therapeutic phlebotomy (mean number of units collected, 36.6) was effective in reducing mean ferritin concentration and transferrin saturation from 1726.9 to 93.0 mg per L and from 54.7 to 23.3 percent, respectively. The presence of a HH gene mutation did not influence initial iron status or response to treatment. The phlebotomy program was well tolerated and no adverse events were recorded during or after collection. In three cases the time between phlebotomies was increased because of patient's poor compliance or low Hb levels.


CONCLUSIONS
Our study shows that phlebotomies are a safe and effective method for reducing iron over-load in multiply transfused long-term AL survivors with secondary hemochromatosis.
Franchini
Massimo
M
Immunhematology and Transfusion Service, Hospital of Verona, Verona, Italy. massimo.franchini@mail.azosp.vr.it
Gandini
Giorgio
G
Veneri
Dino
D
de Matteis
Giovanna
G
Federici
Francesca
F
Solero
Pietro
P
Aprili
Giuseppe
G
D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006432:Hemochromatosis / Q000150:complications / Q000235:genetics; D006801:Humans; D019190:Iron Overload / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D007938:Leukemia / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D018962:Phlebotomy / Q000009:adverse effects; D011446:Prospective Studies; D012449:Safety; D017741:Survivors; D014168:Transferrin / Q000032:analysis; D065227:Transfusion Reaction
D014168:Transferrin; D005293:Ferritins