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

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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 4 months; 44% had received more than 50 units since their MDS diagnosis. Medium serum ferritin was 1,550 μg/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 International Prognostic Scoring System (IPSS), French-American-British (FAB), and/or World Health Organization (WHO) status, though chelated patients had received more RBC transfusions (p = 0.014). Iron chelation therapy may be underutilized in transfusion-dependent patients. Undertreatment can be reduced by complementing sound clinical judgment with the generally accepted guidelines of a serum ferritin level >1,000 μg/L and/or two or more RBC transfusions per month for the past year; considering patients on the basis of their IPSS, FAB, and/or WHO status; and individually tailored treatment regimens. Prospective randomized trials are necessary to establish causally the efficacy of iron chelation therapy in MDS.

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Acknowledgments

This study was sponsored by Novartis Pharma. The authors thank the other investigators in this study, as well as their staff: Marc André, Charleroi; Yves Beguin, Liège; Dominique Boulet, Mons; Dimitri Breems, Antwerpen; Randal D’Dondt, Oostende ; Robrecht De Bock, Wilrijk ; Dries Deeren, Roeselare ; Anne Deweweire, Baudour ; André Efira, Brussel; Walter Feremans, Bruxelles; Augustin Ferrant, Woluwe; Kurt Geldhof, Ieper; Jan Lemmens, Wilrijk; Lucien Noens, Gent; Marjan Petrick, Gent; Pascal Pierre, Arlon; Ann Van de Velde, Edegem; Koen Van Eygen, Kortrijk; Steven Van Steenweghen, Liège; Wim Wynendaele, Bonheiden; all in Belgium. The authors also thank Erin Arizmendi for her editorial, proofreading, and administrative assistance.

Disclosures of conflicts of interest

All authors completed the ICMJE uniform disclosure form for potential conflicts of interest. W. Pluymers is an employee of Novartis Pharma. Abraham and K. MacDonald are employees of Matrix45. By company policy, they are prohibited from owning equity in client organizations (except through mutual funds or other independent collective investment instruments) or contracting independently with client organizations. Matrix45 provides similar services to other biopharmaceutical companies on a nonexclusivity basis.

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Authors and Affiliations

  1. Universitaire Ziekenhuizen Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    Michel Delforge

  2. Algemeen Ziekenhuis Sint-Jan, Ruddershove 10, 8000, Brugge, Belgium

    Dominik Selleslag

  3. Centre Hospitalier Universitaire de Charleroi, Rue de Gozée 706, 6110, Montigny-le-Tileul, Belgium

    Agnès Triffet

  4. Hôpital St. Joseph, Rue de la Duchère, 6060, Gilly, Belgium

    Philippe Mineur

  5. Sint-Elisabethziekenhuis, Rubensstraat 166, 2300, Turnhout, Belgium

    Greet Bries

  6. Cliniques Universitaires UCL de Mont-Godinne, Av. Dr. Gaston Thérasse 1, 5530, Yvoir, Belgium

    Carlos Graux

  7. Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Belgium

    Fabienne Trullemans

  8. Matrix45, 620 Frays Ridge Road, Earlysville, VA, 22936, USA

    Karen MacDonald & Ivo Abraham

  9. Center for Health Outcomes and Pharmacoeconomic Research, and Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 N. Martin, Tucson, AZ, 85721, USA

    Ivo Abraham

  10. Novartis Pharma, Medialaan 40 bus 1, Vilvoorde, Belgium

    Wim Pluymers

  11. Centre Hospitalier de Jolimont-Lobbes, Rue Ferrer 159, Haine-St-Paul, and Institut J. Bordet, Boulevard de Waterloo 121, Brussels, Belgium

    Christophe Ravoet

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  1. Michel Delforge
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  4. Philippe Mineur
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  6. Carlos Graux
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  7. Fabienne Trullemans
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  8. Karen MacDonald
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  9. Ivo Abraham
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  10. Wim Pluymers
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Corresponding author

Correspondence to Michel Delforge.

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Prior dissemination

Poster presentation at the 2009 Congress of the European Haematological Association, Berlin, Germany, June 4–7, 2009. Concurrent abstract published as: Delforge M, Selleslag D, Triffet A, et al. The use of iron chelation therapy for transfusion-dependent myelodysplastic syndrome patients: a cross-sectional study in Belgium. Haematologica, 2009;94: abstract 0806

Michel Delforge, Dominik Selleslag, and Christophe Ravoet, on behalf of the Belgian Hematology Society.

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Delforge, M., Selleslag, D., Triffet, A. et al. Iron status and treatment modalities in transfusion-dependent patients with myelodysplastic syndromes. Ann Hematol 90, 655–666 (2011). https://doi.org/10.1007/s00277-011-1164-9

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  • DOI: https://doi.org/10.1007/s00277-011-1164-9

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