Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements.
The main objective of the study was to analyze the incidence of iron overload (IO) and its management in transfusion-dependent patients with low-risk myelodysplastic syndrome (MDS) before the license of deferasirox. This observational, cross-sectional, and multicenter study was conducted from January to May 2007 in 81 Spanish hospitals. Eligible patients had a low or intermediate-1 risk score and had to have received at least ten units of packed red blood cell (PRBC). Of the 549 patients analyzed, 75% had received more than 20 PRBC units since diagnosis; 14% had IO at diagnosis and 58% at last follow-up. Thirty-eight percent of patients received chelation therapy; of those, 92% were treated with desferrioxamine. Ferritin levels at the start of chelation therapy were higher than 1,000 microg/L in 76% and over 2,500 microg/L in 24% of patients. Of the 202 patients who received some form of chelation therapy, ferritin levels increased from a mean +/- SD of 1,986 +/- 1,398 to 2,480 +/- 1,648 microg/L at last follow-up in 86% (p < 0.001). In the remaining 29 patients treated with a minimally effective therapy, ferritin levels did not increase. Of these, only 11 patients received such therapy lasting more than 12 months. In conclusion, most low-risk transfusion-dependent MDS patients develop IO, but only a minority receives a minimally effective and timely iron chelation therapy.
Remacha
Angel F
AF
Hematology Department, Centro Hospitalario de Toledo, Avenida Barber, 30., 45004, Toledo, Spain. aremacha@sescam.jccm.es
Arrizabalaga
Beatriz
B
Del Cañizo
Consuelo
C
Sanz
Guillermo
G
Villegas
Ana
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001565:Benzoates / Q000627:therapeutic use; D015913:Chelation Therapy; D000077588:Deferasirox; D003676:Deferoxamine / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D019190:Iron Overload / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D014230:Triazoles / Q000627:therapeutic use
D001565:Benzoates; D007502:Iron Chelating Agents; D014230:Triazoles; D005293:Ferritins; D003676:Deferoxamine; D000077588:Deferasirox