title: Toward resolving the unsettled role of iron chelation therapy in myelodysplastic syndromes.
abstract: Transfusion dependent low risk myelodysplastic syndromes (MDS) patients, eventually develop iron overload. Iron toxicity, via oxidative stress, can damage cellular components and impact organ function. In thalassemia major patients, iron chelation therapy lowered iron levels with recovery of cardiac and liver functions and significant improvement in survival. Several noncontrolled studies show inferior survival in MDS patients with iron overload, including an increase in transplant-related mortality and infection risk while iron chelation appears to improve survival in both lower risk MDS patients and in stem cell transplant settings. Collated data are presented on the pathophysiological impact of iron overload; measuring techniques and chelating agents' therapy positive impact on hematological status and overall survival are discussed. Although suggested by retrospective analyses, the lack of clear prospective data of the beneficial effects of iron chelation on morbidity and survival, the role of iron chelation therapy in MDS patients remains controversial.
authors.affiliation: Division of Hematology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel.
authors.forename: Drorit G
authors.initials: DG
authors.lastname: Merkel
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000284:Administration, Oral; D001565:Benzoates / Q000494:pharmacology; D001803:Blood Transfusion; D015913:Chelation Therapy; D000077588:Deferasirox; D000077543:Deferiprone; D003676:Deferoxamine / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000032:analysis / Q000378:metabolism; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019190:Iron Overload / Q000503:physiopathology; D015470:Leukemia, Myeloid, Acute / Q000209:etiology; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D011728:Pyridones / Q000627:therapeutic use; D014230:Triazoles / Q000494:pharmacology
chemical_list: D001565:Benzoates; D007502:Iron Chelating Agents; D011728:Pyridones; D014230:Triazoles; D000077543:Deferiprone; D005293:Ferritins; D007501:Iron; D003676:Deferoxamine; D000077588:Deferasirox
keywords: chelating agents; deferasirox; deferiprone; deferoxamine; iron; myelodysplastic syndrome