title: Iron chelation therapy of transfusion-dependent β-thalassemia during pregnancy in the era of novel drugs: is deferasirox toxic?
abstract: The life expectancy of thalassemic patients has increased, and now approaches that of healthy individuals, thanks to improved treatment regimens. However, pregnancy in women with β-Thalassemia Μajor remains a challenging condition. Recent advances in managing this haemoglobinopathy offer the potential for safe pregnancies with favorable outcome. However, clinical data regarding the use of chelation therapy during pregnancy are limited, and it is unclear whether these agents impose any risk to the developing fetus. Successful pregnancies following unintentional treatment with deferoxamine or deferasirox have rarely been reported. Generally, chelators are not recommended during pregnancy. Regarding the new oral chelators, data on fetotoxicity are lacking. In the present study, we describe the evolution and successful outcome of nine pregnancies in six Greek thalassemic women who received deferasirox inadvertently during early pregnancy, and review the literature regarding fetal anomalies due to chelators. Use of chelation before embarking upon a non-programmed pregnancy remains a difficult and unresolved question. In our study, chelation treatment during pregnancy did not prevent the delivery of healthy children. Nonetheless, the use of deferasirox is contraindicated in pregnant women, based on the product label. Deferasirox should only be used during pregnancy if the potential benefit outweighs the potential fetal risk.
authors: Thalassemia Unit, General Hospital of Larissa, Tsakalov St. 1, 41221, Larissa, Greece. diamantidis76@gmail.com.
authors: Michael D
authors: MD
authors: Diamantidis
authors: Thalassemia Unit, Department of Haematology, Second Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki (AUTH), Konstantinoupoleos St. 49, 54 642, Thessaloniki, Greece.
authors: Nikolaos
authors: N
authors: Neokleous
authors: Thalassemia Unit, Department of Haematology, Second Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki (AUTH), Konstantinoupoleos St. 49, 54 642, Thessaloniki, Greece.
authors: Aleka
authors: A
authors: Agapidou
authors: Thalassemia Unit, Department of Haematology, Second Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki (AUTH), Konstantinoupoleos St. 49, 54 642, Thessaloniki, Greece.
authors: Evaggelia
authors: E
authors: Vetsiou
authors: Thalassemia Unit, General Hospital of Larissa, Tsakalov St. 1, 41221, Larissa, Greece.
authors: Achilles
authors: A
authors: Manafas
authors: Thalassemia Unit, General Hospital of Larissa, Tsakalov St. 1, 41221, Larissa, Greece.
authors: Paraskevi
authors: P
authors: Fotiou
authors: Thalassemia Unit, Department of Haematology, Second Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki (AUTH), Konstantinoupoleos St. 49, 54 642, Thessaloniki, Greece. efivlachaki@yahoo.gr.
authors: Efthymia
authors: E
authors: Vlachaki
mesh_terms: D000328:Adult; D001565:Benzoates / Q000009:adverse effects / Q000627:therapeutic use*; D015913:Chelation Therapy; D000077588:Deferasirox; D000077543:Deferiprone; D003676:Deferoxamine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007502:Iron Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use*; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use*; D017086:beta-Thalassemia / Q000150:complications* / Q000188:drug therapy*
chemical_list: D001565:Benzoates; D007502:Iron Chelating Agents; D011728:Pyridones; D014230:Triazoles; D000077543:Deferiprone; D003676:Deferoxamine; D000077588:Deferasirox
keywords: Chelation therapy; Deferasirox; Deferiprone; Deferoxamine; Pregnancy; β-Τhalassemia major (β-ΤΜ)