title: Can iron overload in patients with lower-risk myelodysplastic syndromes be reduced using erythropoiesis-stimulating agents?
abstract: Iron overload (IOL) portends inferior outcome in myelodysplastic syndromes (MDS). Erythropoiesis-stimulating agents (ESA) may reduce red blood cell transfusion requirements. MDS patients receiving ESA were reviewed for characteristics, response to ESA by International Working Group 2006 criteria and ferritin levels. Forty-nine patients received an ESA, had ferritin levels available, and were not receiving iron chelation therapy. Baseline characteristics were not significantly different between ESA responders (ER) and non-responders (ENR; P = NS). The median ESA treatment duration was 6.7 (1.5-85.9) months. Twenty-one (43 %) patients had an ESA response. Median ferritin level in ER was pre-ESA, 473 (range 91-2727) and post-ESA, 801 (130-11,164) ng/mL (P = 0.01), and in ENR pre-ESA, 672 (76-3285) and post-ESA, 1423 (431-6593) ng/mL (P < 0.0001). There was a significant association between ESA response, post-ESA hemoglobin ≥100 g/L, and post-ESA ferritin <1000 ng/mL (P = 0.0003 and 0.03, respectively). At a median follow-up of 28 months, the 2-year overall survival for ER and ENR, respectively, were 80 % and 86 % (P = NS). In lower-risk MDS patients responding to ESA, although an expected decrease in ferritin levels over treatment was not seen, ferritin levels increased less than in non-responders. Whether IOL may be reduced by ESA over a longer treatment duration may require analysis of larger numbers of patients.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Erica
authors.initials: E
authors.lastname: Tsang
authors.affiliation: Hematology, St. Paul's Hospital and the University of British Columbia, 440-1144 Burrard Street, Vancouver, BC, Canada, V6Z 2A5. hleitch@providencehematology.com.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Leitch
mesh_terms: D000368:Aged; D004920:Erythropoiesis / Q000187:drug effects / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007502:Iron Chelating Agents / Q000494:pharmacology / Q000627:therapeutic use; D019190:Iron Overload / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006397:Hematinics; D007502:Iron Chelating Agents
keywords: ESA; Erythropoiesis-stimulating agents; Ferritin; Iron overload; MDS; Myelodysplastic syndromes