Increased survival and reversion of iron-induced cardiac disease in patients with thalassemia major receiving intensive combined chelation therapy as compared to desferoxamine alone.
Myocardial iron overload is the leading cause of death in patients with beta-thalassemia major. An intensification monotherapy with deferoxamine (DFO) as well as a combination therapy with DFO and deferiprone (DFP) reduces myocardial iron and improves cardiac function. However, the prognosis for thalassemia major patients with established cardiac disease switched from DFO monotherapy to combined DFP/DFO chelation is unknown. Twenty-eight thalassemia major patients with cardiac disease were enrolled in a prospective study lasting 42+/-6 months. Fifteen (9 high-ferritin and 6 low-ferritin) were placed on DFP/DFO (DFP, 75 mg/kg t.i.d.; DFO, 40-50mg/kg over 8-12h at night 5-7 days/week), while 13 (5 high- and 8 low-ferritin) received DFO alone. No cardiac events were observed among high-ferritin patients on combination therapy, whereas 4 cardiac events (p=0.0049), including three deaths, occurred in high-ferritin patients on DFO monotherapy. These findings demonstrate that in thalassemia major patients with well-established cardiac disease combined iron-chelation therapy with DFP/DFO is superior to DFO monotherapy.
Lai
Maria Eliana
ME
Ospedale Regionale per le le Microcitemie, Cagliari, Italy. laie@pacs.unica.it
Grady
Robert W
RW
Vacquer
Stefania
S
Pepe
Alessia
A
Carta
Maria Paola
MP
Bina
Patrizio
P
Sau
Franco
F
Cianciulli
Paolo
P
Maggio
Aurelio
A
Galanello
Renzo
R
Farci
Patrizia
P
D000328:Adult; D009202:Cardiomyopathies / Q000139:chemically induced / Q000188:drug therapy*; D015913:Chelation Therapy; D000077543:Deferiprone; D003676:Deferoxamine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007501:Iron / Q000097:blood; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019190:Iron Overload / Q000188:drug therapy; D008297:Male; D011446:Prospective Studies; D011728:Pyridones / Q000627:therapeutic use*; D015996:Survival Rate; D017086:beta-Thalassemia / Q000188:drug therapy* / Q000401:mortality
D007502:Iron Chelating Agents; D011728:Pyridones; D000077543:Deferiprone; D007501:Iron; D003676:Deferoxamine