title: Relation between chelation and clinical outcomes in lower-risk patients with myelodysplastic syndromes: Registry analysis at 5 years.
abstract: Prospective data are needed to ascertain the impact of iron chelation therapy in patients with myelodysplastic syndromes. The present 5-year prospective registry analysis was conducted to compare clinical outcomes between chelated and nonchelated patients with lower-risk myelodysplastic syndromes and transfusional iron overload. In an interim analysis at 24 months, we previously reported that chelation therapy was associated with longer median overall survival and a tendency toward longer leukemia-free survival and fewer cardiac events. In the present report, we detail findings from the final analysis at 5 years. We confirm, at the conclusion of this 5-year, prospective, non-interventional study, that overall survival was significantly longer in patients who received iron chelation therapy vs those who did not. Causes of death in the overall population were predominantly myelodysplastic syndromes/acute myeloid leukemia followed by cardiac disease. Time to progression to acute myeloid leukemia was also significantly longer in patients receiving chelation therapy, and significantly fewer patients progressed to leukemia vs those not receiving chelation therapy. Limitations of the study include a potential for clinical bias, as patients with longer predicted survival may have been chosen for chelation therapy, the differences present in concomitant conditions at baseline, and the possibility that some high-risk patients were not identified due to limited cytogenetic classification.
authors.affiliation: Texas Oncology and US Oncology Research, 4411 Medical Drive, San Antonio, TX 78229, United States. Electronic address: roger.lyons@usoncology.com.
authors.forename: Roger M
authors.initials: RM
authors.lastname: Lyons
authors.affiliation: Texas Oncology and US Oncology Research, 1901 South 2nd Street, McAllen, TX, 78503, United States. Electronic address: billie.marek@usoncology.com.
authors.forename: Billie J
authors.initials: BJ
authors.lastname: Marek
authors.affiliation: Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, United States. Electronic address: carole.paley@novartis.com.
authors.forename: Carole
authors.initials: C
authors.lastname: Paley
authors.affiliation: Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, United States. Electronic address: jason.esposito@novartis.com.
authors.forename: Jason
authors.initials: J
authors.lastname: Esposito
authors.affiliation: Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, United States. Electronic address: katie.mcnamara@novartis.com.
authors.forename: Katie
authors.initials: K
authors.lastname: McNamara
authors.affiliation: Blue Ridge Cancer Care and US Oncology Research, 900 Electric Road, Salem, VA 24153, United States. Electronic address: paul.richards@usoncology.com.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Richards
authors.affiliation: Rocky Mountain Cancer Centers and US Oncology Research, 1700 South Potomac Street, Aurora, CO 80012, United States. Electronic address: nick.dibella@usoncology.com.
authors.forename: Nicholas
authors.initials: N
authors.lastname: DiBella
authors.affiliation: The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, United States. Electronic address: ggarciam@mdanderson.org.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015913:Chelation Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019190:Iron Overload; D015470:Leukemia, Myeloid, Acute / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Iron chelation; Iron overload; Myelodysplastic syndromes