title: Updated recommendations on the management of gastrointestinal disturbances during iron chelation therapy with Deferasirox in transfusion dependent patients with myelodysplastic syndrome - Emphasis on optimized dosing schedules and new formulations.
abstract: Myelodysplastic syndromes (MDS) are oligoclonal hematopoietic disorders characterized by peripheral cytopenias with anemias being the most prevalent feature. The majority of patients will depend on regular transfusions of packed red blood cells (PRBC) during the course of the disease. Particularly patients with MDS and low risk for transformation into acute myeloid leukemia and low risk of early death will receive PRBC transfusions on a regular basis, which puts them at high risk for transfusional iron overload. Transfusion dependence has been associated with negative impact on organ function and reduced life expectancy. Recently, several retrospective but also some prospective studies have indicated, that transfusion dependent patients with MDS might benefit from consequent iron chelation with regard to morbidity and mortality. However, low treatment adherence due to adverse events mainly gastrointestinal in nature is an important obstacle in achieving sufficient iron chelation in MDS patients. Here, we will summarize and discuss the existing data on Deferasirox in low risk MDS published so far and provide recommendations for optimal management of gastrointestinal adverse events during iron chelation aiming at improving treatment compliance and, hence, sufficiently removing excess iron from the patients.
authors: Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Germany. Electronic address: florian.nolte@medma.uni-heidelberg.de.
authors: Florian
authors: F
authors: Nolte
authors: Hematology and Bone Marrow Transplant Unit, and Medical Oncology Department, Ospedale Oncologico "Armando Businco", Cagliari, Italy.
authors: Emanuele
authors: E
authors: Angelucci
authors: Department of Cellular Biotechnologies and Hematology, "La Sapienza" University, Rome, Italy.
authors: Massimo
authors: M
authors: Breccia
authors: Comprehensive Cancer Center and Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany.
authors: Norbert
authors: N
authors: Gattermann
authors: Division of Hematology, University of Florence, Florence, Italy.
authors: Valeria
authors: V
authors: Santini
authors: Department of Hematology, Institute Paoli Calmettes, Marseille, France.
authors: Norbert
authors: N
authors: Vey
authors: Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Germany.
authors: Wolf-Karsten
authors: WK
authors: Hofmann
mesh_terms: D001565:Benzoates / Q000008:administration & dosage* / Q000009:adverse effects; D015913:Chelation Therapy / Q000009:adverse effects*; D000077588:Deferasirox; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007502:Iron Chelating Agents / Q000008:administration & dosage* / Q000009:adverse effects; D009190:Myelodysplastic Syndromes / Q000188:drug therapy*; D065227:Transfusion Reaction; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D001565:Benzoates; D007502:Iron Chelating Agents; D014230:Triazoles; D000077588:Deferasirox
keywords: Chelation; Deferasirox; Gastrointestinal disturbances; Iron overload; Myelodysplastic syndrome; Transfusion