Effect of Deferasirox Chelation on Liver Iron and Total Body Iron Concentration
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To determine efficacy of Deferasirox (DFX) on total body iron and liver iron concentration (LIC) as estimated by serum ferritin (SF) and liver MRI T2*.
Thirty patients had baseline MRI T2* of the liver performed to determine LIC before starting DFX therapy and classified as normal >6.3 milliseconds (ms), mild 6.3−2.7 ms, moderate 2.7−1.4 ms and severe iron overload <1.4 ms. DFX was given 25–35 mg/kg/d. The serum ferritin (SF) level was estimated every 3 monthly. Liver iron is expressed as liver R2* = 1000/T2*. The primary end point of the study was to determine change in SF and liver MRI R2* values after 18 mo of therapy.
All 30 patients had some degree of liver iron overload; 11 (36.6 %) had severe, 15 (50 %) had moderate while 4 (13.3 %) had mild overload. The pre-DFX therapy median SF of all was 3604.5 ng/mL (IQR 2357.0–5056.0) and median liver R2* was 574.71 Hz (IQR 411.3–770.8). After 18 mo, SF dropped significantly to a median of 2036.5 ng/mL (IQR 1700.0–3162.0) (p = 0.0011), while median liver R2* decreased from 574.71 to 568.18Hz (IQR 393.4–803.2) which was not significant (p = 0.986).
DFX monotherapy at the doses used decreases total body iron, but does not significantly decrease liver iron. It is well tolerated by Indian thalassemia patients, with observed side effects including rash, diarrhea, and transient albuminuria. MRI T2* (and derived R2*) can serve as useful method in non invasive monitoring of LIC in thalassemia patient management.
KeywordsThalassemia Liver iron concentration Liver MRI T2*/R2* Serum ferritin Deferasirox
The authors are thankful to Dr. Deepak Langde for his inputs and analysis of statistical data and Mrs. Gracy Simond (Nurse Incharge of Thalassemia Transfusion Centre Nanavati Hospital) for maintaining data and nursing care of their patients.
RHM conceptualized the study and was principal investigator. JA is responsible for data collection, monitoring and along with NA for manuscript write-up. BJ and PK are the radiologists reporting MRI T2*and contributed to the manuscript.
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