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

Abstract

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.

l‐Mimosine and Dimethyloxaloylglycine Decrease Plasminogen Activation in Periodontal Fibroblasts

“…Prolyl hydroxylase inhibitors are not new to the clinic. For example, iron chelation therapy is applied in β‐thalassemia, 23 sickle cell disease, 24 and myelodysplastic syndromes 25 . However, only data from preclinical research are available regarding using hydroxylase inhibitors to support tissue regeneration.…”

Iron Overload during Follow-up after Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with High-Risk Neuroblastoma

“…However, at present, experience of iron chelation treatment after SCT, particularly with deferasirox, is very limited. Elevation of serum creatinine levels during deferasirox treatment has frequently been reported (19, 20), and the US Food and Drug Administration (FDA) black box warning for deferasirox includes renal failure (21). This poses as a challenge in using deferasirox to treat iron overload in HDCT/autoSCT recipients, as they may be more susceptible to possible adverse effects of iron chelation treatment than chronic anemia patients due to previous chemoradiotherapy.…”

Deferasirox for Porphyria Cutanea Tarda

“…4 It has also been used in the treatment of other iron overload states, such as sickle cell disease 5 and myelodysplastic syndromes. 6 The recommended starting dose for iron overload states secondary to chronic transfusion is 20 mg/kg/d, with an increase in dose for unresponsive patients not to exceed 40 mg/kg/d.…”