Management of transfusion-related iron overload in patients with myelodysplastic syndromes.
Anemia is a common symptom for patients with myelodysplastic syndromes (MDS), a spectrum of hematopoietic malignancies characterized by ineffective hematopoiesis; 90% of these patients will become transfusion dependent (TD). Because of the closed nature of iron metabolism, the repeated input of packed red blood cells during transfusions inevitably leads to iron overload. Iron overload can cause iron-related toxicity as well as end-organ damage from iron deposition in tissues. Studies have shown that patients with MDS who are TD have shorter overall survival, shorter leukemia-free survival, and higher healthcare costs compared with patients who are not TD, suggesting that iron overload has a significant clinical and economic impact. Iron chelation therapy can bind and eliminate free iron from the body. Although studies in genetic anemias have shown improved clinical outcomes, clinical trials with patients with MDS are ongoing. Because iron chelation therapy can be toxic, the risks, benefits, and therapy-related costs must be weighed for each patient.
Leukemia Division, John Theurer Cancer Center, Hackensack University Medical Center, New Jersey, USA. jshah@humed.com
Jayshree
J
Shah
Sandra E
SE
Kurtin
Louise
L
Arnold
Petra
P
Lindroos-Kolqvist
Sara
S
Tinsley
D001565:Benzoates / Q000627:therapeutic use; D015913:Chelation Therapy / Q000379:methods; D000077588:Deferasirox; D000077543:Deferiprone; D003676:Deferoxamine / Q000627:therapeutic use; D006801:Humans; D007501:Iron / Q000009:adverse effects*; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000628:therapy; D018962:Phlebotomy; D011728:Pyridones / Q000627:therapeutic use; D017262:Siderophores / Q000627:therapeutic use; D065227:Transfusion Reaction; D014230:Triazoles / Q000627:therapeutic use
D001565:Benzoates; D007502:Iron Chelating Agents; D011728:Pyridones; D017262:Siderophores; D014230:Triazoles; D000077543:Deferiprone; D007501:Iron; D003676:Deferoxamine; D000077588:Deferasirox