Ironing out the details of iron overload in myelofibrosis: Lessons from myelodysplastic syndromes.
Myelofibrosis (MF) and myelodysplastic syndrome (MDS) are hematopoietic stem cell disorders associated with cytopenias and red blood cell (RBC) transfusion dependence. Iron overload (IO) as a consequence of RBC transfusion dependence and its effect on outcomes in MF has not been formally studied. However, IO is a demonstrated poor prognostic feature in patients with MDS and congenital or acquired chronic anemias. Evidence that iron chelation therapy (ICT) reduces the deleterious effects of IO in MDS has led to speculation of benefit in MF. However, data supporting the use of ICT in MF is lacking. Neither disease has clear consensus guidelines for the use of ICT. Moreover, JAK-STAT inhibition, the cornerstone of MF treatment, often contributes to anemia and transfusional requirements. This manuscript reviews known and potential implications of IO in MF and highlights the need for prospective clinical investigations of ICT with consideration in the setting of JAK2 inhibitor therapy.
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Nicole
N
Carreau
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Douglas
D
Tremblay
Department of Medicine, Vanderbilt-Ingram Cancer Center/Vanderbilt University School of Medicine, Nashville, TN, United States.
Michael
M
Savona
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Marina
M
Kremyanskaya
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: john.mascarenhas@mssm.edu.
John
J
Mascarenhas
D001803:Blood Transfusion / Q000379:methods*; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000628:therapy*; D009190:Myelodysplastic Syndromes / Q000188:drug therapy*; D055728:Primary Myelofibrosis / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome
D007502:Iron Chelating Agents
Iron chelation therapy; Iron overload; Myelodysplastic syndrome; Myelofibrosis