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Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements

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Abstract

The main objective of the study was to analyze the incidence of iron overload (IO) and its management in transfusion-dependent patients with low-risk myelodysplastic syndrome (MDS) before the license of deferasirox. This observational, cross-sectional, and multicenter study was conducted from January to May 2007 in 81 Spanish hospitals. Eligible patients had a low or intermediate-1 risk score and had to have received at least ten units of packed red blood cell (PRBC). Of the 549 patients analyzed, 75% had received more than 20 PRBC units since diagnosis; 14% had IO at diagnosis and 58% at last follow-up. Thirty-eight percent of patients received chelation therapy; of those, 92% were treated with desferrioxamine. Ferritin levels at the start of chelation therapy were higher than 1,000 μg/L in 76% and over 2,500 μg/L in 24% of patients. Of the 202 patients who received some form of chelation therapy, ferritin levels increased from a mean ± SD of 1,986 ± 1,398 to 2,480 ± 1,648 μg/L at last follow-up in 86% (p < 0.001). In the remaining 29 patients treated with a minimally effective therapy, ferritin levels did not increase. Of these, only 11 patients received such therapy lasting more than 12 months. In conclusion, most low-risk transfusion-dependent MDS patients develop IO, but only a minority receives a minimally effective and timely iron chelation therapy.

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Acknowledgements

The authors are grateful to all the patients who participated in this study and the 114 hematologists who contributed to the data collection; to HealthCo (Madrid, Spain) for assistance with preparation of the manuscript and to Novartis Spain for funding the project.

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Authors and Affiliations

  1. Hematology Department, Centro Hospitalario de Toledo, Avenida Barber, 30., 45004, Toledo, Spain

    Angel F. Remacha

  2. Hospital de Cruces, Barakaldo, Spain

    Beatriz Arrizabalaga

  3. Hospital Universitario de Salamanca, Salamanca, Spain

    Consuelo Del Cañizo

  4. Hospital La Fe, Valencia, Spain

    Guillermo Sanz

  5. Hospital Clínico San Carlos, Madrid, Spain

    Ana Villegas

Authors
  1. Angel F. Remacha
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  2. Beatriz Arrizabalaga
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  3. Consuelo Del Cañizo
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  4. Guillermo Sanz
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  5. Ana Villegas
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Corresponding author

Correspondence to Angel F. Remacha.

Appendix

Appendix

Participating physicians and affiliations are, in alphabetical order, as follows: Aguado Bueno, Hospital de la Princesa (Madrid), Allegue Vilaso, Complejo Hospitalario de Pontevedra (Pontevedra), Almagro Sánchez de Puerta, Hospital Virgen de las Nieves (Granada), Alonso Rosa, Hospital Virgen del Rocío (Sevilla), Altes Hernández, Hospital Espíritu Santo (Barcelona), Álvarez Rivas, Hospital Reina Sofía (Córdoba), Andreu Lapiedra, Hospital Universitario Dr. Peset (Valencia), Arrizabalaga Amuchastegui, Hospital de Cruces (Vizcaya), Atutxa Aresti, Hospital Comarcal de Galdácano (Vizcaya), Bailén García, Hospital Carlos Haya (Málaga), Barbón Fernández, Hospital de León (León), Bargay Llonart, Hospital Sont Llatzer (Baleares), Beltrán de Heredia, Hospital de Basurto (Vizcaya), Benavente Cuesta, Hospital Clínico San Carlos (Madrid), Bendaña López (Hospital Clínico Universitario Santiago Compostela (La Coruña), Bermejo Estevan, Hospital Sagrado Corazón (Barcelona), Bernal del Castillo, Hospital Universitario Central de Asturias (Asturias), Biedma López, Hospital San Juan de la Cruz (Jaén), Blanchard Rodríguez, Hospital Ramón y Cajal (Madrid), Bombin Canal, Hospital Ramón y Cajal (Madrid), Bosch Llobet, Hospital de Mataró (Barcelona), Calavia Lacarra, Hospital San Millán (La Rioja), Cano Luis, Complejo Hospitalario 'La Mancha-Centro' Ciudad Real), Carbonell Ramón, Consorcio Hospital General (Valencia), Carrascosa Vallejo, Hospital Comarcal de Galdácano (Vizcaya), Casaño Sánchez, Hospital Reina Sofía (Córdoba), Castro Mouzo, Complejo Hospitalario de Vigo-Hospital Xeral-Cíes (Pontevedra), Cladera Serra, Hospital Sont Llatzer (Baleares), Clavero Ferrer, Hospital Torrecárdenas (Almería), Clavero Sánchez Hospital de Motril (Granada), De la Rubia Hospital Universitario La Fe (Valencia), De Paz Arias, Hospital Universitario La Paz (Madrid), Del Campo Rincón Complejo Hospitalario 'La Mancha-Centro' (Ciudad Real), Del Cañizo Fernández Roldán, Hospital C.U. de Salamanca (Salamanca), Del Castillo Rueda, Hospital Gregorio Marañón (Madrid), Durán Nieto, Hospital Ciudad de Jaén (Jaén), Duran Pastor, Hospital Son Dureta (Baleares), Estany Raluy, Hospital Mutua Terrassa (Barcelona), Esteban Muñoz, Hospital Ciudad de Jaén (Granada), Fernández de la Mata, Hospital Infanta Margarita—Cabra (Córdoba), Fernández Lago, Complejo Hospitalario Juan Canalejo (La Coruña), Figueredo Manrique, Hospital Virgen de la Macarena (Sevilla), Font Ferré, Hospital Tortosa Verge de la Cinta (Tarragona), Franco Osorio, Hospital Punta de Europa (Cádiz), Funes Vera, Hospital Santa Maria del Rosell (Murcia), Gallardo Giralt, Instituto Catalán de Oncologia (ICO; Barcelona), García Delgado, Hospital Clínico Universitario de Málaga (Málaga), García Frade, Hospital Rio Hortega (Valladolid), García Hernández, Hospital General Universitario de Alicante (Alicante), García Menoyo, Hospital de Basurto (Vizcaya), García Pintos, Consorcio Sanitario de Terrassa (Barcelona), Giraldo Castellanos, Hospital Miguel Servet (Zaragoza), Gómez García de Soria, Hospital de la Princesa (Madrid), González González, Hospital Universitario de Canarias (Tenerife), González Navarro, Hospital Nuestra Señora de la Salud (Granada), Gonzalez Porras, Hospital Clínico Universitario de Salamanca (Salamanca), González Rodríguez, Hospital de Cabueñes (Asturias), Gorosquieta Sánchez, Hospital de Navarra (Navarra), Groiss Buiza, Hospital Infanta Cristina (Badajoz), Guerra Hernando, Hospital Sont Llatzer (Baleares), Guzmán Zamudio, Hospital del SAS de Jérez (Cádiz), Hernández Regi, Hospital de Calella (Barcelona), Lemes Castellano, Hospital Dr. Negrín Las Palmas Gran Canaria (Canarias), León Lara, Hospital de Jerez de la Frontera (Cádiz), Llorente Cabrera, Hospital Juan XXIII (Tarragona), López García-Carreño, Hospital Santa Maria del Rosell (Murcia), López Garrido, Hospital Virgen de las Nieves (Granada), López López, Hospital Virgen del Puerto (Cáceres), Macía Virgili, Hospital Universitario Arnau de Vilanova (Lerida), Márquez Navarro, Hospital de Basurto (Vizcaya), Martí Tutusaus, Hospital Mutua Terrassa (Barcelona), Martín Antorán, Hospital Universitario Rio Hortega (Valladolid), Martínez Bilbao, Hospital Comarcal de Galdácano (Vizcaya), Mascaró Riera, Hospital Sont Llatzer (Baleares), Menchaca Echevarría, Hospital Xagorritxu de Vitoria (Álava), Montesinos Fernández, Hospital Universitario La Fe (Valencia), Muñoz Muñoz, Hospital Puerta el Mar (Cádiz), Navarro Álvarez, Hospital Virgen de las Nieves (Granada), Ojanguren Bergaz, Hospital Comarcal de Aldácano (Vizcaya), Ojeda Gutiérrez, Clínica Puerta de Hierro (Madrid), Olabarría Santuizun, Hospital de Basurto (Vizcaya), Orriols Bernet, Fundación Manresa Althaia (Barcelona), Ortega Rivas Centro Asistencial de Palencia (Palencia), Ortíz Conde, Hospital Universitario 12 de Octubre (Madrid), Osorio Prendes Hospital Gregorio Marañón (Madrid), Palomera Bernal Hospital Clínico de Zaragoza (Zaragoza), Pascual García, Hospital Príncipe de Asturias-Alcalá de Henares (Madrid), Pedro Olivé, Hospital del Mar (Barcelona) Pérez Mendiguren Ruiz de Olalla, Hospital General Yagüe (Burgos), Pérez-Pons de la Villa, Hospital Severo Ochoa-Leganés (Madrid), Peris Vidal, Hospital Municipal de Badalona (Barcelona), Plensa Alberca Hospital de Mataró (Barcelona), Prieto Pareja, Fundación Jiménez Díaz (Madrid), Rabasa Garaibar, Hospital San Millán (La Rioja), Ramos Ortega, Hospital de León (León), Remacha Sevilla, Hospital de la Santa Creu i Sant Pau (Barcelona), Requena Vilaplana, Hospital San Juan de la Cruz (Jaén), Ríos Tamayo, Hospital Comarcal Valle de los Pedroches (Córdoba), Rodríguez Fernández, Hospital de Mataró (Barcelona), Rodríguez Rodríguez, Hospital Juan Ramón Jiménez (Huelva), Ruiz Marco, Hospital General de Albacete (Albacete), Sánchez García, Hospital Vall d'Hebron (Barcelona), Sánchez García, Hospital Reina Sofía (Córdoba), Sánchez-Tello de Carranza, Hospital Arnau de Vilanova (Valencia), Sanz Santillana, Hospital Universitario La Fe (Valencia), Solano Ramos, Hospital Ntra. Sra. del Prado-Talavera de la Reina (Toledo), Solano Vercet, Hospital Clínico Universitario de Valencia (Valencia), Soler Campos, Hospital Parc Taulí (Barcelona), Tejedor Gutiérrez, Hospital Santa Maria del Rosell (Murcia), Torres González, Hospital Torrecárdenas (Almería), Uranga Uranga, Hospital Donostia (Guipúzcoa), Urbano Ramos, Hospital Comarcal Valle de los Pedroches (Córdoba), Vela Payan, Hospital de Calella (Barcelona), Verruga Oñate, Hospital San Juan de la Cruz (Jaén), Vicente Folch, Consorcio Sanitario de Terrassa (Barcelona), Vicente García Hospital Universitario Morales Meseguer (Murcia), Villegas Martínez, Complejo Universitario San Carlos (Madrid), Xicoy Cirici, Hospital German Trias i Pujol (Barcelona), Yáñez Sansegundo, Hospital Marqués de Valdecilla (Santander).

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Remacha, A.F., Arrizabalaga, B., Del Cañizo, C. et al. Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements. Ann Hematol 89, 147–154 (2010). https://doi.org/10.1007/s00277-009-0794-7

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  • DOI: https://doi.org/10.1007/s00277-009-0794-7

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