title: Decision points in the treatment of transfusional iron overload in patients with myelodysplastic syndromes: why, when, and how to chelate.
abstract: Patients with myelodysplastic syndromes (MDS) differ from those with other transfusion-dependent conditions (eg, thalassemia) as they are typically older, have comorbid conditions, and a generally shorter life expectancy. The underlying disease process in MDS and frequent use of red blood cell transfusions lead to iron accumulation and ultimately organ damage. Whether iron-reducing interventions such as chelation therapy can improve outcomes in this population is currently under investigation. Areas covered: We reviewed published English-language articles from PubMed on the topic of iron overload (IO) in MDS, and the use of iron chelation therapies (ICTs) to alleviate iron burden. Expert commentary: Data on IO-associated complications in MDS are derived largely from retrospective studies and there are limited data to guide clinicians on major treatment decisions. Although effective and well-tolerated oral ICTs are available, and general recommendations may be made regarding usage in MDS, guidance is not yet based on prospective data. The clinical endpoints and assessments for MDS may differ substantively from those used in patients with thalassemia, as an older population may have competing causes for morbidity. We expect that emergent data from clinical trials currently underway will define more appropriate endpoints/assessments for the MDS population in clinical trials.
authors.affiliation: a Lipson Cancer and Blood Center , Rochester Regional Health System , Rochester , NY , USA.
authors.forename: Farhan
authors.initials: F
authors.lastname: Imran
authors.affiliation: a Lipson Cancer and Blood Center , Rochester Regional Health System , Rochester , NY , USA.
authors.forename: Pradyumna
authors.initials: P
authors.lastname: Phatak
mesh_terms: D001706:Biopsy; D015913:Chelation Therapy; D000066491:Clinical Decision-Making; D003663:Decision Trees; D006801:Humans; D007501:Iron / Q000378:metabolism; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019190:Iron Overload / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000628:therapy*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D061665:Time-to-Treatment; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: D007502:Iron Chelating Agents; D007501:Iron
keywords: Cytopenia; hematopoiesis; iron chelation therapy; iron overload; myelodysplastic syndromes; red blood cell transfusion