Estudio del tratamiento con desferroxamina en perfusión subcutánea para la sobrecarga de hierro en pacientes con síndrome mielodisplásico

. Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements. Annals of Hematology, Springer Verlag, 2009, 89 (2) Abstract 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% (p<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.

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

Remacha

Arrizabalaga

Cañizo

et al. 2009

Ann Hematol

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Iron status and treatment modalities in transfusion-dependent patients with myelodysplastic syndromes

et al. 2011

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 3 ABSTRACT Transfusion-dependency and iron overload are common among patients with myelodysplastic syndromes (MDS) treated with red blood cell (RBC) transfusions.Transfusion-dependency is associated with leukemic progression and shorter survival.Guidelines recommend iron chelation therapy to manage iron overload, however little is known about the chelation patterns in daily clinical practice. The objective of this multicenter, retrospective, cross-sectional, observational study was to evaluate iron status and its management in transfusion-dependent MDS patients. A total of 193 patient records from 29 centers were eligible for inclusion. Median patient age was 76 and median age at diagnosis of MDS was 74. Patients had received an average of 13.4+7.6 RBC units in the past four months; 44% had received more than 50 units since their MDS diagnosis. Medium serum ferritin was 1550g/L. Ninety patients (46.6%) received iron chelation therapy with either deferoxamine (41%), deferasirox (36%), and deferoxamine followed by deferasirox (23%). There were no statistically significant differences between chelated and nonchelated patients in terms of IPSS, FAB, and/or WHO status, though chelated patients had received more RBC transfusions (p=0.014).Iron chelation therapy may be underutilized in transfusion-dependent patients.

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Decision points in the treatment of transfusional iron overload in patients with myelodysplastic syndromes: why, when, and how to chelate

Phatak

2016

Expert Review of Hematology

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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.

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Estudio del tratamiento con desferroxamina en perfusión subcutánea para la sobrecarga de hierro en pacientes con síndrome mielodisplásico

Cited by 5 publications

References 8 publications

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

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

Iron status and treatment modalities in transfusion-dependent patients with myelodysplastic syndromes

Decision points in the treatment of transfusional iron overload in patients with myelodysplastic syndromes: why, when, and how to chelate

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