<scp>MRI</scp> for the diagnosis of cardiac and liver iron overload in patients with transfusion‐dependent thalassemia: An algorithm to guide clinical use when availability is limited

Viprakasit, Vip; Ajlan, Amr M.; Aydınok, Yeşim; Ebadi, B; Dewedar, Hany; Ibrahim, Ahmed S.; Ragab, Lamis; Trad, Omar; Wataify, Ahmed S.; Wong, Lily; Taher, Alì

doi:10.1002/ajh.25075

Cited by 18 publications

(13 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unlike thalassemia, it is not clear how to interpret the LIC values in acute leukemia patients who require RBC transfusion during the induction period of treatment. However, it is recommended that 7 mg / gr d.w. can be considered as a cut-off in the prediction of clinical complications (4,13,27). When we evaluated LIC results of our cohorts according to this cutoff value, it can be concluded that one patient (3.3%) has iron accumulation with under a risk of clinical complication.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment

Acar

Gözmen

Bayraktaroğlu

et al. 2020

Tjh

Self Cite

View full text Add to dashboard Cite

Objective: There are limited number of studies evaluating iron overload in childhood leukemia by magnetic resonance imaging (MRI). The aim of this study was to determine the liver iron content (LIC) by MRI in children with acute lymphoblastic leukemia (ALL), who had been completed treatment, and to compare with serum iron parameters. Materials and Methods: A total of 30 patients between the ages of 7 and 18 who completed ALL treatment were included in the study. Serum iron parameters [serum iron, serum ferritin (SF), and total iron binding capacity], liver function tests were studied. R2 MRI was performed for determining LIC. Results: Normal LIC were detected in 22 (63.4%) of the cases. Seven (23.3%) had mild and 1 (3.3%) had moderate liver iron deposition. In contrast, severe iron overload was not detected in any of the cases. LIC levels were correlated with the numbers of packet red blood cell (pRBC) transfusions (r = 0.637, p <0.001), pRBC transfusion volume (r = 0.449, p <0.013), SF levels (r = 0.561, p = 0.001), transferrin saturation (r=0.353 , p = 0.044). In addition, a positive correlation was found between the number of pRBC transfusions and SF levels (r = 0.595, p <0.001). Conclusion:We showed that the frequency of liver iron deposition was low and clinically less significant after the end of the treatment in childhood ALL patients. LIC was u n c o r r e c t e d p r o o f demonstrated to be related with SF and transfusion history. These findings support that SF and transfusion history may be used as a reference for monitoring iron accumulation or identifying cases for further examination such as MRI. Tedavisi Tamamlanmış Akut Lenfoblastik Lösemili Çocuklarda Manyetik Rezonans Görüntüleme ile Karaciğer Demir İçeriğinin Değerlendirilmesi ÖzAmaç: Çocukluk çağı lösemisinde aşırı demir yükünü manyetik rezonans görüntüleme (MRG) ile değerlendiren sınırlı sayıda çalışma vardır. Bu çalışmanın amacı, ALL'ı olan ve tedavisini tamamlamış olan çocuklarda R2 MRI yöntemiyle karaciğer demir içeriğini (LIC) belirlemek ve serum demir parametreleriyle karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya ALL tedavisini tamamlayan 7-18 yaşları arasında toplam 30 hasta alındı. Serum demir parametreleri [serum demir, serum ferritin (SF) ve toplam demir bağlama kapasitesi], karaciğer fonksiyon testleri çalışıldı. Karaciğer demir içeriğini (LIC) belirlemek için R2 MRG yöntemi kullanıldı. Bulgular: Olguların 22'sinde (% 63,4) normal LIC saptandı. Yedi (% 23,3) olguda hafif ve 1 (% 3,3) olguda orta derecede karaciğerde demir birikimi mevcuttu. Buna karşılık, hiçbir olguda ciddi derecede demir birikimi tespit edilmedi. LIC seviyeleri, pRBC transfüzyonu sayısı (r = 0.637, p <0.001), pRBC transfüzyon miktarı (r = 0.449, p <0.013), SF seviyeleri (r = 0.561, p = 0.001), transferrin (r = 0.353, p = 0.044) ile korele saptandı. Ek olarak, pRBC transfüzyonlarının sayısı ile SF seviyeleri arasında pozitif korelasyon bulundu (r = 0.595, p <0.001). Sonuç: Çocukluk çağı ALL hastalarında tedavi bitiminden sonra karaciğer demir birikiminin sıklığının...

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment

Acar

Gözmen

Bayraktaroğlu

et al. 2020

Tjh

Self Cite

View full text Add to dashboard Cite

show abstract

“…[11][12][13] A suggested approach to optimising iron chelator therapy in patients with transfusion-dependent thalassaemia and high iron stores when magnetic resonance imaging (MRI) results are available is shown in Figure 1. 12,14 Patients with satisfactory iron stores (serum ferritin consistently 500-1500 μg/L and liver iron concentration [LIC] 3-7 mg Fe/g dry weight [dw]) and myocardial T2* (mT2*) >20 milliseconds can continue their current iron chelator regimen or be offered deferasirox if their current regimen is not tolerated or associated with poor adherence, or if they request a change. 11,13 The iron chelator dose should be reduced or treatment should be interrupted in patients with rapidly decreasing or low iron stores (ie, serum ferritin consistently <1000 μg/L and LIC <3 mg Fe/g dw).…”

Section: Introductionmentioning

confidence: 99%

“…11,12 If MRI is not available, it is recommended that serial serum ferritin levels should be obtained every 3 months and used to monitor iron overload. 14 The efficacy of deferasirox DT in patients with transfusiondependent thalassaemia and iron overload is well established.…”

Section: Introductionmentioning

confidence: 99%

“…Factors to consider when selecting an iron chelator include iron burden, patient preference, tolerability and adherence . A suggested approach to optimising iron chelator therapy in patients with transfusion‐dependent thalassaemia and high iron stores when magnetic resonance imaging (MRI) results are available is shown in Figure . Patients with satisfactory iron stores (serum ferritin consistently 500‐1500 μg/L and liver iron concentration [LIC] 3‐7 mg Fe/g dry weight [dw]) and myocardial T2* (mT2*) >20 milliseconds can continue their current iron chelator regimen or be offered deferasirox if their current regimen is not tolerated or associated with poor adherence, or if they request a change .…”

Section: Introductionmentioning

confidence: 99%

“…The iron chelator dose should be reduced or treatment should be interrupted in patients with rapidly decreasing or low iron stores (ie, serum ferritin consistently <1000 μg/L and LIC <3 mg Fe/g dw) . If MRI is not available, it is recommended that serial serum ferritin levels should be obtained every 3 months and used to monitor iron overload …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optimising management of deferasirox therapy for patients with transfusion‐dependent thalassaemia and lower‐risk myelodysplastic syndromes

Kattamis

Aydınok

Taher

2018

European J of Haematology

Self Cite

View full text Add to dashboard Cite

Effective iron chelation therapy is an important part of treatment in patients with transfusion-dependent thalassaemia and lower-risk myelodysplastic syndromes (MDS). Key strategies for optimising iron chelation therapy include ensuring good adherence and preventing and managing adverse events (AEs). Good adherence to iron chelation therapy with deferoxamine and deferasirox has been linked to improved survival and/or reductions in complications related to iron overload; however, maintaining good adherence to iron chelators can be challenging. Patients with transfusion-dependent thalassaemia or lower-risk MDS showed better adherence to the deferasirox film-coated tablet (FCT) formulation than to the deferasirox dispersible tablet formulation in the ECLIPSE trial, reflecting in part the improved palatability and convenience of deferasirox FCT. As well as affecting adherence, AEs may lead to dose reduction, interruption or discontinuation, resulting in suboptimal iron chelation therapy. Preventing and successfully managing AEs may help limit their impact on adherence, and following dosage and administration recommendations for iron chelators such as deferasirox may help minimise AEs and optimise treatment in patients with transfusion-dependent thalassaemia and lower-risk MDS.

show abstract

Transfusion burden in early childhood plays an important role in iron overload in Diamond‐Blackfan anaemia

Wilde

Dooijeweert

Vuren

et al. 2022

eJHaem

View full text Add to dashboard Cite

In Diamond‐Blackfan anaemia (DBA), iron overload (IO) is common in transfusion‐dependent patients, yet has also been reported in non‐transfusion‐dependent patients. We explored the incidence of IO in transfusion‐dependent and non‐transfusion‐dependent DBA patients. We observed hepatic IO in 65% of patients analysed with MRI, including three patients that were only treated with transfusions in the past. Whereas overall ferritin levels and liver iron content correlated, ferritin levels did not reflect total body iron adequately. Our data suggest that transfusion burden in the past plays an important role in IO in DBA, and should be taken into account during follow up.

show abstract

MRI for the diagnosis of cardiac and liver iron overload in patients with transfusion‐dependent thalassemia: An algorithm to guide clinical use when availability is limited

Cited by 18 publications

References 9 publications

Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment

Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment

Optimising management of deferasirox therapy for patients with transfusion‐dependent thalassaemia and lower‐risk myelodysplastic syndromes

Transfusion burden in early childhood plays an important role in iron overload in Diamond‐Blackfan anaemia

Contact Info

Product

Resources

About