improved control of body iron burden, 6,7 compared with a transfusion schedule (termed ''supertransfusion'') in which HE LAST 3 decades have witnessed profound changes in the management of patients with thalassemia major. Regular red blood cell (RBC) transfusions eliminate the baseline hemoglobins are permitted to exceed 11 g/dL. 8 complications of anemia and compensatory bone marrow Type of RB C Concentrates (BM) expansion, permit normal development throughout childhood, and extend survival. 1 In parallel, transfusions re-Early studies of the use of neocytes, or young RBCs, sult in a ''second disease'' while treating the first, 2 that predicted that prolonged survival in vivo of these concenof the inexorable accumulation of tissue iron that, without trates should reduce the RBC mass required to maintain treatment, is fatal in the second decade of life. Further alterappropriate baseline hemoglobin concentrations. 8-11 Clinical ing the prognosis of thalassemia major over the last 20 years investigations confirmed that an extension of transfusion inhas been progress in the development of iron-chelating therterval of 13% to 25% in thalassemia could be achieved with apy for iron overload. Deferoxamine mesylate, first introthe use of neocytes. 12-16 A recent study found that a 15% duced in short-term studies in iron-loaded patients in the extension of transfusion interval during administration of early 1960s, gained acceptance as standard therapy over a neocyte concentrates, expected to minimally reduce the redecade later in countries able to support the high costs of quirement for iron chelation therapy, could be achieved but this therapy. Twenty years later, extended survival free of at the cost of an increased exposure to donated units and a iron-induced complications, and dramatically improved fivefold increment in preparation expenses over those of quality of life, are observed in well-chelated patients. Indeed, standard concentrates. 16 Hence, the use of neocytes should over this period, iron-chelating therapy for thalassemia major have a limited impact on the long-term management of most has resulted in one of the most dramatic alterations in morchronically transfused patients. In contrast, the use of autobidity and mortality associated with a genetic disease. In this mated RBC exchange transfusions in regularly transfused review the experience gained in the use of deferoxamine, patients with sickle cell disease has been reported to substanthe benefits of and problems associated with this agent in tially reduce transfusional iron accumulation, permitting rethe treatment and prevention of iron overload, and recent duction in the intensity of chelation therapy. 17 Pilot studies progress in the development of orally effective iron-chelating in thalassemia major 18 suggest that a similar approach may drugs will be reviewed. warrant careful evaluation in this disorder.