Does iron chelation therapy improve survival in regularly transfused lower risk MDS patients? A multicenter study by the GFM (Groupe Francophone des Myélodysplasies).
BACKGROUND
Iron chelation therapy (CT) improves survival in thalassemia major but its beneficial effects on survival in MDS patients remain uncertain.


METHODS
We analyzed, by multivariate analysis, survival and causes of deaths in 97 low or intermediate 1 IPSS patients regularly transfused as outpatients, chelated or not, who were included during a month period and followed for 2.5 years.


RESULTS
44 (45%) of patients were not chelated and 53 (55%) received CT, mainly with deferoxamine, for at least 6 months (median duration of chelation 36 months, range 6-131+). During the follow-up period, 66 of the 97 patients died, including 51% and 73% of chelated and non-chelated patients, respectively. Median overall survival was 53 months and 124 months in non-chelated and in chelated patients (p<0.0003). Causes of death did not significantly differ between the two groups (p=0.51). In multivariate Cox analysis, adequate chelation was the strongest independent factor associated with better OS.


CONCLUSIONS
Iron chelation therapy appears to improve survival in heavily transfused lower risk MDS, but prospective randomized studies are required to confirm our findings, and to determine more precisely the mechanisms of this potential survival benefit.
Service d'Onco-Hématologie, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France.
Christian
C
Rose
Sabine
S
Brechignac
Dominique
D
Vassilief
Laurent
L
Pascal
Aspasia
A
Stamatoullas
Agnes
A
Guerci
Dalila
D
Larbaa
François
F
Dreyfus
Odile
O
Beyne-Rauzy
Marie Pierre
MP
Chaury
Lydie
L
Roy
Stephane
S
Cheze
Pierre
P
Morel
Pierre
P
Fenaux
D000368:Aged; D000369:Aged, 80 and over; D015913:Chelation Therapy; D015897:Comorbidity; D003676:Deferoxamine / Q000008:administration & dosage / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007501:Iron; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019190:Iron Overload / Q000188:drug therapy* / Q000209:etiology; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D016019:Survival Analysis; D065227:Transfusion Reaction
D007502:Iron Chelating Agents; D005293:Ferritins; D007501:Iron; D003676:Deferoxamine