The role of magnetic resonance imaging in the evaluation of transfusional iron overload in myelodysplastic syndromes

Abstract

Myelodysplastic syndromes represent a group of heterogeneous hematopoietic neoplasms derived from an abnormal multipotent progenitor cell, characterized by a hyperproliferative bone marrow, dysplasia of the cellular hemopoietic elements and ineffective erythropoiesis. Anemia is a common finding in myelodysplastic syndrome patients, and blood transfusions are the only therapeutic option in approximately 40% of cases. The most serious side effect of regular blood transfusion is iron overload.Currently, cardiovascular magnetic resonance using T2 is routinely used to identify patients with myocardial iron overload and to guide chelation therapy, tailored to prevent iron toxicity in the heart. This is a major validated non-invasive measure of myocardial iron overloading and is superior to surrogates such as serum ferritin, liver iron, ventricular ejection fraction and tissue Doppler parameters.The indication for iron chelation therapy in myelodysplastic syndrome patients is currently controversial. However, cardiovascular magnetic resonance may offer an excellent non-invasive, diagnostic tool for iron overload assessment in myelodysplastic syndromes. Further studies are needed to establish the precise indications of chelation therapy and the clinical implications of this treatment on survival in myelodysplastic syndromes.

Iron Overload in Myelodysplastic Syndromes: Pathophysiology, Consequences, Diagnosis, and Treatment

“…Magnetic resonance imaging of the liver (e.g., liver R2 or R2*), heart (e.g., cardiac T2*), or endocrine glands (e.g., pancreas R2*) is also increasingly being investigated as a means to evaluate IO in MDS patients (Petrou et al, 2015;Wood, 2015). For example, the liver is a central organ for the storage of excess iron in the body and MRI-based estimates of LIC have become the gold standard for assessing IO (Armand et al, 2011;Merkel & Nagler, 2014).…”

“…yelodysplastic syndromes (MDS) encompass a heterogeneous group of hematologic malignancies that are characterized by ineffective hematopoiesis and risk for progression to acute myeloid leukemia (AML; Mitchell, Gore, & Zeidan, 2013;Petrou et al, 2015;Shah, Kurtin, Arnold, Lindroos-Kolqvist, & Tinsley, 2012). The majority of patients with MDS (approximately 80%) are anemic, and a large percentage of them will require red blood cell (RBC) transfusional support during their disease course (Shenoy, Vallumsetla, Rachmilewitz, Verma, Ginzburg, 2014;Temraz, Santini, Musallam, & Taher, 2014).…”

Myelodysplastic Disorders, 5q-Syndrome

“…Anemia is a very common finding in MDS patients [51,52]. Packed RBC transfusions are the only therapeutic option in 40% of MDS patients [51,52].…”

“…Anemia is a very common finding in MDS patients [51,52]. Packed RBC transfusions are the only therapeutic option in 40% of MDS patients [51,52]. RBC transfusions are considered in MDS patients when Hb level falls below 8 g/dL and may provide temporary relief of anemic symptoms [51,52].…”

“…Packed RBC transfusions are the only therapeutic option in 40% of MDS patients [51,52]. RBC transfusions are considered in MDS patients when Hb level falls below 8 g/dL and may provide temporary relief of anemic symptoms [51,52]. Anemia contributes to cardiac dysfunction predominantly in elderly individuals [51].…”