Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements

Angel F. Remacha (1) , Beatriz Arrizabalaga (2) , Consuelo Cañizo (3) , Guillermo Sanz (4) , Ana Villegas (5)

1 Hematology Department
2 Hospital de Cruces
3 Hospital Universitario de Salamanca
4 Hospital La Fe
5 Hospital Clínico San Carlos

The main objective of the study was to analyze the incidence of iron overload (IO) and its management in transfusion-dependent patients with low-risk myelodysplastic syndrome (MDS) before the license of deferasirox. This observational, cross-sectional, and multicenter study was conducted from January to May 2007 in 81 Spanish hospitals. Eligible patients had a low or intermediate-1 risk score and had to have received at least ten units of packed red blood cell (PRBC). Of the 549 patients analyzed, 75% had received more than 20 PRBC units since diagnosis; 14% had IO at diagnosis and 58% at last follow-up. Thirty-eight percent of patients received chelation therapy; of those, 92% were treated with desferrioxamine. Ferritin levels at the start of chelation therapy were higher than 1,000 μg/L in 76% and over 2,500 μg/L in 24% of patients. Of the 202 patients who received some form of chelation therapy, ferritin levels increased from a mean ± SD of 1,986 ± 1,398 to 2,480 ± 1,648 μg/L at last follow-up in 86% ( < 0.001). In the remaining 29 patients treated with a minimally effective therapy, ferritin levels did not increase. Of these, only 11 patients received such therapy lasting more than 12 months. In conclusion, most low-risk transfusion-dependent MDS patients develop IO, but only a minority receives a minimally effective and timely iron chelation therapy.

Mots clés: MDS; Chelation; Iron; Overload; DFO; Deferasirox

Angel F. Remacha, Beatriz Arrizabalaga, Consuelo Cañizo, Guillermo Sanz, Ana Villegas. Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements. Annals of Hematology, 2009, 89 (2), pp.147-154. ⟨10.1007/s00277-009-0794-7⟩. ⟨hal-00535080⟩