title: Safety and efficacy of high dose intravenous desferrioxamine for reduction of iron overload in sickle cell disease.
abstract: BACKGROUND
  Patients with sickle cell disease (SCD) receiving chronic blood transfusions are at risk of developing iron overload and organ toxicity. Chelation therapy with either subcutaneous (SQ) desferrioxamine (DFO) or oral deferasirox is effective in preventing and reducing iron overload but poses significant challenges with patient compliance. Intravenous (IV) infusions of high dose DFO have been utilized in non-compliant patients with heavy iron overload in small case series.
  
  
  METHODS
  We review our experience of high dose IV DFO in 27 patients with SCD who had significant iron overload and were noncompliant with subcutaneous (SQ) DFO. All patients were treated in-hospital with DFO 15 mg/kg/hr IV for 48 hr every 2-4 weeks with a mean duration of 19.6 months.
  
  
  RESULTS
  We observed a significant decrease in liver iron burden with high dose intermittent IV DFO. Histological examination of liver biopsies revealed a decrease in the grade of liver iron storage. Also there was significant improvement in liver enzymes (ALT, AST) after high dose IV DFO. No audiologic or ophthalmologic toxicity or acute or chronic pulmonary complications were observed.
  
  
  CONCLUSIONS
  In our cohort of patients with SCD we observed a significant decrease in liver iron burden with high dose IV DFO. Our patients tolerated the therapy well without any major toxicity. This regimen is safe and may be an option for poorly compliant patients with significant iron overload.
authors.affiliation: Division of Pediatric Hematology and Oncology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Ram
authors.initials: R
authors.lastname: Kalpatthi
authors.forename: Brittany
authors.initials: B
authors.lastname: Peters
authors.forename: Ian
authors.initials: I
authors.lastname: Kane
authors.forename: David
authors.initials: D
authors.lastname: Holloman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rackoff
authors.forename: Deborah
authors.initials: D
authors.lastname: Disco
authors.forename: Sherron
authors.initials: S
authors.lastname: Jackson
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Laver
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Abboud
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000473:pathology; D001219:Aspartate Aminotransferases / Q000097:blood; D015913:Chelation Therapy / Q000009:adverse effects; D002648:Child; D003676:Deferoxamine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007262:Infusions, Intravenous; D019190:Iron Overload / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008099:Liver / Q000473:pathology; D008297:Male; D017262:Siderophores / Q000008:administration & dosage* / Q000009:adverse effects; D065227:Transfusion Reaction; D055815:Young Adult
chemical_list: D017262:Siderophores; D005293:Ferritins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003676:Deferoxamine