Combined chelation therapy in thalassemia major with deferiprone and desferrioxamine: a retrospective study

Abstract

This study showed that the administration of DFO for 5 d a wk in combination with daily administration of DFP at 75 mg/Kg seemed to be the most efficacy and rapid method for reducing iron overload at liver and heart level. Furthermore, the use of different schedules of combined DFO and DFP administration was not associated with different incidence of adverse effects between the groups.

The impact of previous or concomitant IFN therapy on deferiprone-induced agranulocytosis and neutropenia: a retrospective study

“…Overall, we observed 3 (4.5%) cases of agranulocytosis and 26 of neutropenia in 16 (24.2%) patients; consistently to what was previously observed for patients in combined treatment [4], also in this larger series the use of different DFP daily dose was not associated to a significant different incidence of haematological adverse events (data not shown). In 10 (15.1%) patients, due to the prolonged permanence of the event, DFP discontinuation was required (prolonged neutropenia).…”

“…Out of 3 case of agranulocytosis, 2 were observed under combined regimen, the other under alternate regimen of DFP administration. All the 3 cases of agranulocytosis were related to the use of PEG-IFN: 2 patients (one cotreated, the other pretreated) were under combined treatment [4], the other was in DFP alternate treatment and had discontinued IFN treatment 6 months before the start of DFP therapy. The rate of agranulocytosis in patients who received IFN compared with those not treated was 12.0 versus 0%.…”

“…However, neutropenia is commonly encountered during treatment with IFN for hepatitis C, and in the pivotal trials~20% of patients had their Peg-IFN dose reduced for neutropenia [3]. In a recently published study we have documented that during DFP and DFO combined treatment, the two cases of DFP-induced agranulocytosis were related to the use of IFN [4]. Thus, to test the hypothesis that IFN may influence the occurrence of DFP-induced haematological toxicity in a larger population, we retrospectively analyzed the incidence of neutropenia and agranulocytosis in all patients who had been treated at our centre with DFP and also pretreated or cotreated with IFN.…”

Combined Chelation Therapy with Daily Oral Deferiprone and Twice-Weekly Subcutaneous Infusion of Desferrioxamine in Children with β-Thalassemia: 3-Year Experience

“…Under those circumstances, the chelating potential of DFO is maximized and DFP would not transfer iron to other serum iron-binding proteins, like ferritin [35]. Many other studies using various regimens of oral DFP combined with subcutaneous DFO as chelation treatment in iron-overloaded β-thalassemia patients, who had previously been unable to achieve a satisfactory response to DFP or DFO alone, had followed [10,20,21,22,23,24,25,26,27]. They all demonstrated the effectiveness of the combination in decreasing serum ferritin.…”

“…Deferiprone (DFP), a cheaper oral iron chelator proven effective in achieving a negative iron balance in many short- and long-term clinical trials in adult patients with iron overload[3,4,5,6,7,8,9], has recently been studied for its efficacy and safety in thalassemia children receiving chelation [10,11,12,13,14,15,16,17]. To improve the efficacy of chelation treatment, the ‘iron shuttle hypothesis' [18,19] has been proposed, leading to many studies on the combined use of DFP and DFO [10,11,20,21,22,23,24,25,26,27,28,29,30]. …”