title: Utility of labile plasma iron and transferrin saturation in addition to serum ferritin as iron overload markers in different underlying anemias before and after deferasirox treatment.
abstract: OBJECTIVE
  Plasma markers in addition to serum ferritin (SF) may be useful for the assessment of iron overload; however, predictive utility may differ depending on underlying, transfusion-dependent, anemias.
  
  
  METHODS
  Data were collected before and after 1 year of deferasirox treatment (end of study; EOS) from the large, 1-year EPIC (Evaluation of Patients' Iron Chelation with Exjade(®) ) study. Trends were evaluated between liver iron concentration (LIC), transferrin saturation (TfSat), predose labile plasma iron (LPI) and their relationship to SF categories in 1530 patients: thalassemia major (TM; n = 1114), myelodysplastic syndromes (MDS, n = 336), and sickle-cell disease (SCD, n = 80).
  
  
  RESULTS
  Baseline and EOS SF values showed a clear and similar relationship to LIC for all disease groups. TfSat also showed a relationship to SF, most clearly in patients with SCD, where TfSat was lowest in the lowest relative SF category. Unlike SF or LIC, TfSat did not decrease at EOS in any disease group. Baseline LPI was raised in TM and MDS, but not in patients with SCD, decreasing at EOS in both patient groups. After 1 year of chelation therapy, there was a significant trend for greater LPI reduction in patients with TM achieving LIC <7 mg Fe/g dw (P = 0.0137).
  
  
  CONCLUSIONS
  Despite limitations, SF showed the clearest relationship, of the plasma markers evaluated, to LIC before and after 1 year of deferasirox in patients with TM, MDS, and SCD. In patients with TM, changes in LPI with chelation show a significant relationship to EOS LIC and may provide an additional indicator of chelation response (clinicaltrials.gov identifier: NCT00171821).
authors.affiliation: University College London, London, UK.
authors.forename: John B
authors.initials: JB
authors.lastname: Porter
authors.affiliation: Ain Shams University, Cairo, Egypt.
authors.forename: Mohsen
authors.initials: M
authors.lastname: El-Alfy
authors.affiliation: Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Vip
authors.initials: V
authors.lastname: Viprakasit
authors.affiliation: Hôpital Henri Mondor, Créteil, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Giraudier
authors.affiliation: University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Lee Lee
authors.initials: LL
authors.lastname: Chan
authors.affiliation: The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
authors.forename: Yongrong
authors.initials: Y
authors.lastname: Lai
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: El-Ali
authors.affiliation: Novartis Pharmaceuticals, East Hanover, NJ, USA.
authors.forename: Jackie
authors.initials: J
authors.lastname: Han
authors.affiliation: Policlinico Foundation IRCCS, Università di Milano, Milan, Italy.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Cappellini
mesh_terms: D000740:Anemia / Q000097:blood / Q000188:drug therapy; D001565:Benzoates / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D000077588:Deferasirox; D005260:Female; D005293:Ferritins / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D007501:Iron / Q000097:blood*; D019190:Iron Overload / Q000097:blood / Q000188:drug therapy; D008297:Male; D014168:Transferrin / Q000378:metabolism*; D014230:Triazoles / Q000008:administration & dosage*
chemical_list: D001565:Benzoates; D015415:Biomarkers; D014168:Transferrin; D014230:Triazoles; D005293:Ferritins; D007501:Iron; D000077588:Deferasirox
keywords: chelation therapy; iron overload; myelodysplastic syndromes; sickle-cell disease; thalassemia major