scholarly journals Iron Chelation Therapy in Myelodysplastic Syndromes

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Emanuela Messa ◽  
Daniela Cilloni ◽  
Giuseppe Saglio
Keyword(s):  
Iron Overload ◽  
Myelodysplastic Syndromes ◽  
Chelation Therapy ◽  
Therapeutic Option ◽  
Iron Chelation ◽  
Iron Chelation Therapy ◽  
Hematopoietic Stem ◽  
The Future ◽  
Clinical Consequences ◽  
Transfusion Dependency

Myelodysplastic syndromes (MDS) are a heterogeneous disorder of the hematopoietic stem cells, frequently characterized by anemia and transfusion dependency. In low-risk patients, transfusion dependency can be long lasting, leading to iron overload. Iron chelation therapy may be a therapeutic option for these patients, especially since the approval of oral iron chelators, which are easier to use and better accepted by the patients. The usefulness of iron chelation in MDS patients is still under debate, mainly because of the lack of solid prospective clinical trials that should take place in the future. This review aims to summarize what is currently known about the incidence and clinical consequences of iron overload in MDS patients and the state-of the-art of iron chelation therapy in this setting. We also give an overview of clinical guidelines for chelation in MDS published to date and some perspectives for the future.

Objectives of iron chelation therapy in myelodysplastic syndromes: more than meets the eye?

Blood ◽  
2009 ◽  
Vol 114 (26) ◽  
pp. 5251-5255 ◽  
Author(s):  
Vinod Pullarkat
Keyword(s):  
Iron Overload ◽  
Cardiac Dysfunction ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Low Grade ◽  
Iron Chelation Therapy ◽  
Hematopoietic Stem ◽  
Tissue Iron ◽  
Transfusion Dependency ◽  
Major Argument

AbstractThe role of iron chelation therapy in myelodysplastic syndrome (MDS) remains controversial. Averting cardiac dysfunction in low-grade MDS patients who have sufficient longevity to experience deleterious cardiac effects of iron overload has been the major argument in favor of iron chelation. Although there is significant evidence showing the adverse impact of transfusion dependency on survival in MDS, direct evidence linking tissue iron overload to poor survival or in particular to cardiac dysfunction is lacking. Given the heterogeneity of MDS, it is likely that the pathophysiology of iron overload is equally heterogeneous and complex in these patients. In this article, I argue that prevention of cardiac dysfunction in patients with lower grades of MDS may not be the major benefit of iron chelation therapy, and present evidence suggesting a potential benefit of iron chelation on 3 other outcomes, namely (1) lowering infection risk, (2) improving the outcome of allogeneic hematopoietic stem cell transplantation, and (3) delaying leukemic transformation. These outcomes have particular relevance for patients with higher grades of MDS and should be evaluated in future prospective clinical trials that include patients with all grades of MDS to fully evaluate the benefit of iron chelation therapy.

The Role of Iron Chelation Therapy for Patients With Myelodysplastic Syndromes

2011 ◽  
Vol 9 (1) ◽  
pp. 65-75 ◽  
Author(s):  
David P. Steensma
Keyword(s):  
Iron Overload ◽  
Myelodysplastic Syndromes ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Clinical Intervention ◽  
Iron Chelation Therapy ◽  
Careful Attention ◽  
High Quality ◽  
Iron Parameters

The appropriate role of iron chelation therapy in the management of patients with myelodysplastic syndromes (MDS) is currently controversial. Some investigators interpret data to indicate that careful attention to iron parameters, with early initiation of iron chelation in patients with evidence suggesting transfusion-associated iron overload, is an important component of high-quality MDS patient care. Other physicians are more skeptical, noting that chelation can be cumbersome or costly, has associated risks, and has not yet been shown to reduce morbidity or mortality in the MDS setting. This article reviews the extent to which iron chelation therapy might be either an important clinical intervention in MDS or a distraction from more pressing clinical concerns.

Should Patients with Myelodysplastic Syndromes Undergo Iron Chelation Therapy? New Data Answering the Question

2009 ◽  
Vol 02 ◽  
pp. 60
Author(s):  
Stuart L Goldberg ◽  
Keyword(s):  
Iron Overload ◽  
Myelodysplastic Syndromes ◽  
Scoring System ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
World Health ◽  
International Prognostic Scoring System ◽  
Iron Chelation Therapy ◽  
Older Individuals ◽  
Prospective Trials

Although it is well established that transfusional iron overload leads to organ impairment and shortened survival among children with thalassemia and sickle cell anemia, the role of transfusional iron overload and its treatment among older individuals with the myelodysplastic syndromes (MDS) remains unclear. Recent reviews have noted that MDS patients requiring frequent red blood cell transfusions experience higher rates of cardiac, hepatic, endocrine, and other organ damage in patterns similar to pediatric transfusional hemochromatosis, with increased rates of transformation to leukemia and decreased survival. Through the use of prognostic scoring systems such as the International Prognostic Scoring System (IPSS) and the World Health Organization (WHO) classification-based prognostic scoring system (WPSS), MDS patients with projected survivals long enough to warrant concern about the toxicities of iron overload can be identified and iron chelation therapies can be considered. The results of two large prospective trials among transfusion-dependent MDS patients, US03 and EPIC, have demonstrated that the oral iron chelation agent deferasirox can successfully reduce iron content and has an acceptable safety profile in this elderly population. Furthermore, retrospective trials have suggested that iron chelation therapy may prolong survival in MDS, and prospective trials are being planned. This article will highlight some of these issues.

301 IRON OVERLOAD AND IRON CHELATION THERAPY WITH DEFERASIROX IN TRANSFUSION-DEPENDENT PATIENTS WITH MYELODYSPLASTIC SYNDROMES

2015 ◽  
Vol 39 ◽  
pp. S150
Author(s):  
L. Del Corso ◽  
A. Bacigalupo ◽  
E. Balleari ◽  
A. Bellodi ◽  
T. Calzamiglia ◽  
...  
Keyword(s):  
Iron Overload ◽  
Myelodysplastic Syndromes ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelation Therapy
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