title: Adequate iron chelation therapy for at least six months improves survival in transfusion-dependent patients with lower risk myelodysplastic syndromes.
abstract: BACKGROUND
  Most patients with myelodysplastic syndromes (MDS) require transfusions at the risk of iron overload and associated organ damage, and death. Emerging evidence indicates that iron chelation therapy (ICT) could reduce mortality and improve survival in transfusion-dependent MDS patients, especially those classified as International Prognostic Scoring System (IPSS) Low or Intermediate-1 (Low/Int-1).
  
  
  METHODS
  Follow-up of a retrospective study. Sample included 127 Low/Int-1 MDS patients from 28 centers in Belgium. Statistical analysis stratified by duration (≥6 versus <6 months) and quality of chelation (adequate versus weak).
  
  
  RESULTS
  Crude chelation rate was 63% but 88% among patients with serum ferritin ≥1000 μg/L. Of the 80 chelated patients, 70% were chelated adequately mainly with deferasirox (26%) or deferasirox following deferoxamine (39%). Mortality was 70% among non-chelated, 40% among chelated, 32% among patients chelated ≥6 m, and 30% among patients chelated adequately; with a trend toward reduced cardiac mortality in chelated patients. Overall, median overall survival (OS) was 10.2 years for chelated and 3.1 years for non-chelated patients (p<0.001). For patients chelated ≥6 m or patients classified as adequately chelated, median OS was 10.5 years. Mortality increased as a function of average monthly transfusion intensity (HR=1.08, p=0.04) but was lower in patients receiving adequate chelation or chelation ≥6 m (HR=0.24, p<0.001).
  
  
  CONCLUSIONS
  Six or more months of adequate ICT is associated with markedly better overall survival. This suggests a possible survival benefit of ICT in transfusion-dependent patients with lower-risk MDS.
authors.affiliation: Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Delforge
authors.affiliation: Algemeen Ziekenhuis Sint-Jan, Brugge, Belgium.
authors.forename: Dominik
authors.initials: D
authors.lastname: Selleslag
authors.affiliation: Centre Hospitalier Universitaire de Liège and Université de Liège, Liège, Belgium.
authors.forename: Yves
authors.initials: Y
authors.lastname: Beguin
authors.affiliation: Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
authors.forename: Agnès
authors.initials: A
authors.lastname: Triffet
authors.affiliation: Grand Hôpital de Charleroi, Charleroi, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mineur
authors.affiliation: Jessa Ziekenhuis, Hasselt, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Theunissen
authors.affiliation: Cliniques Universitaires UCL de Mont-Godinne, Mont-Godinne, Belgium.
authors.forename: Carlos
authors.initials: C
authors.lastname: Graux
authors.affiliation: Universitair Ziekenhuis Brussel, Brussel, Belgium.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Trullemans
authors.affiliation: Centre Hospitalier Régional Clinique St. Joseph, Mons, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulet
authors.affiliation: Algemeen Ziekenhuis Groeninge, Kortrijk, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Van Eygen
authors.affiliation: Universitair Ziekenhuis Gent, Gent, Belgium.
authors.forename: Lucien
authors.initials: L
authors.lastname: Noens
authors.affiliation: Centre Hospitalier Régional de la Citadelle, Liège, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Van Steenweghen
authors.affiliation: Algemeen Ziekenhuis St-Augustinus, Wilrijk, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Lemmens
authors.affiliation: Clinique du Sud Luxembourg, Arlon, Belgium.
authors.forename: Pascal
authors.initials: P
authors.lastname: Pierre
authors.affiliation: Algemeen Ziekenhuis Damiaan, Oostende, Belgium.
authors.forename: Randal
authors.initials: R
authors.lastname: D'hondt
authors.affiliation: Cliniques Universitaires UCL St. Luc, Woluwe, Belgium.
authors.forename: Augustin
authors.initials: A
authors.lastname: Ferrant
authors.affiliation: Heilig Hart Ziekenhuis, Roeselare, Belgium.
authors.forename: Dries
authors.initials: D
authors.lastname: Deeren
authors.affiliation: Universitair Ziekenhuis Antwerpen, Edegem, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Van De Velde
authors.affiliation: Algemeen Ziekenhuis Imelda, Bonheiden, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Wynendaele
authors.affiliation: Cliniques Universitaires UCL de Mont-Godinne, Mont-Godinne, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: André
authors.affiliation: Ziekenhuis Netwerk Antwerpen Middelheim, Antwerpen, Belgium.
authors.forename: Robrecht
authors.initials: R
authors.lastname: De Bock
authors.affiliation: Centre Hospitalier Universitaire Brugmann, Bruxelles, Belgium.
authors.forename: André
authors.initials: A
authors.lastname: Efira
authors.affiliation: Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerpen, Belgium.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Breems
authors.affiliation: Réseau Hospitalier de Médecine Sociale Baudour, Baudour, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Deweweire
authors.affiliation: Jan Yperman Ziekenhuis, Ieper, Belgium.
authors.forename: Kurt
authors.initials: K
authors.lastname: Geldhof
authors.affiliation: Novartis Pharma, Vilvoorde, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Pluymers
authors.affiliation: Matrix45, Tucson, AZ, USA; Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Harrington
authors.affiliation: Matrix45, Tucson, AZ, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: MacDonald
authors.affiliation: Matrix45, Tucson, AZ, USA; Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA. Electronic address: iabraham@matrix45.com.
authors.forename: Ivo
authors.initials: I
authors.lastname: Abraham
authors.affiliation: Centre Hospitalier de Jolimont, Jolimont, Belgium; Institut Jules Bordet, Bruxelles, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Ravoet
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors
chemical_list: D007502:Iron Chelating Agents
keywords: Cardiac death; Chelation therapy; Iron overload; Myelodysplastic syndromes; Transfusion; Transfusion dependency