Treatment of transfusional iron overload in patients with myelodysplastic syndrome or severe anemia: data from multicenter clinical practices

Raptis, Anastasios; Duh, Mei Sheng; Wang, Si-Tien; Dial, E.; Fanourgiakis, Ilias; Fortner, Barry; Paley, Carole; Mody-Patel, Nikita; Corral, Mitra; Scott, Jeffrey W.

doi:10.1111/j.1537-2995.2009.02361.x

Cited by 40 publications

(46 citation statements)

References 26 publications

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“…Early results from prospective studies of DFX in LR-MDS patients with IO demonstrated significant reductions in serum ferritin, liver iron concentration and hepatic transaminases within 3-6 months, but these studies had limited follow-up and did not report on survival or organ damage outcomes [21][22][23][24]. ICT has been associated in observational studies with improved survival in MDS patients with IO [5][6][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Deferasirox therapy is associated with reduced mortality risk in a medicare population with myelodysplastic syndromes

et al. 2015

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Aims: Iron overload adversely affects patients with myelodysplastic syndromes (MDS), but benefits of iron chelation therapy have not been clearly demonstrated. We examined the association between deferasirox (DFX) therapy and mortality in transfusion-receiving Medicare patients. Patients & methods: MDS patients from 2005 to 2008 were identified using ICD-9 codes from 100% Medicare claims. Patients receiving ≥20 blood units were observed until death or end of study. Marginal structural models were used for estimation. Results: 3926 patients (10.1% used DFX) were observed for a mean of 48.8 weeks. Each incremental week of DFX was associated with a significant reduction in mortality risk (hazard ratio [HR]: 0.989; 95% CI: 0.983-0.996; p = 0.001). Conclusion: DFX therapy is associated with a reduced mortality risk among older MDS patients who received a minimum transfusion threshold.

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Section: Discussionmentioning

confidence: 99%

Deferasirox therapy is associated with reduced mortality risk in a medicare population with myelodysplastic syndromes

et al. 2015

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“…Recently, an association between iron chelation therapy and longer overall survival was shown in patients with MDS or severe anemia requiring multiple blood transfusions, 32,33 and adequate iron chelation therapy is recommended for such patients. 34 The administration of oral iron-chelating agents such as deferasirox may be an attractive treatment for iron-overloaded patients compared with deferoxamine, which requires s.c. or i.v.…”

Section: Category Bacterial Isolatesmentioning

confidence: 99%

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Kanda

Mizumoto

Ichinohe

et al. 2010

Bone Marrow Transplant

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Although fluoroquinolones or other antibiotics are commonly used to prevent bacterial infections after hematopoietic cell transplantation (HCT), because of the growing presence of multidrug-resistant microorganisms, it is important to identify patients who are more likely to benefit from antibacterial prophylaxis. To evaluate risk factors for early bacterial infection after allogeneic HCT, we retrospectively analyzed clinical data for 112 consecutive adult patients with hematological malignancies who received transplants without any antibacterial prophylaxis. The cumulative incidence of bacterial infection at 30 days after transplantation was 16%. Among various pre-transplant factors, only high serum ferritin (4700 ng/mL, 47 patients) and high C-reactive protein (CRP) (40.3 mg/dL, 28 patients) levels were significantly associated with the development of bacterial infection in a multivariate analysis (hazard ratio (95% confidence interval): ferritin, 4.00 (1.32-12.17); CRP, 3.64 (1.44-9.20)). In addition, septic shock and sepsis with organ failure were exclusively observed in patients who had high ferritin and/or high CRP levels. These results suggest that pretransplant serum ferritin and CRP levels can be useful markers for predicting the risk of early bacterial infection after allogeneic HCT. It may be prudent to limit antibacterial prophylaxis to patients with predefined risk factors to ensure the safety of HCT with the use of fewer antibiotics.

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“…35,36 Despite the aforementioned studies, the literature is full of weak attempts to overstate the danger of iron overload in patients with MDS and the unproven value of iron chelation therapy. [37][38][39][40][41][42] Most of these studies inappropriately used serum ferritin as the surrogate for both clinically relevant disease and treatment effect, and some have even flirted with retrospective comparison of patients who have or have not received iron chelation therapy. The fact is that physicians are more likely to administer iron chelation therapy to patients in whom a longer life expectancy is anticipated, and, therefore, nothing short of a prospective randomized study can provide the information needed to justify the use of a potentially toxic and officially expensive form of treatment.…”

Section: Azacitidine and Decitabinementioning

confidence: 99%

Myelodysplastic Syndromes—Many New Drugs, Little Therapeutic Progress

Tefferi

2010

Mayo Clinic Proceedings

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Treatment of transfusional iron overload in patients with myelodysplastic syndrome or severe anemia: data from multicenter clinical practices

Abstract: This study finds only 41% of ICT-eligible patients with lower-risk MDS received ICT in clinical practice, and treatment was initiated later than recommended. Receipt of ICT was associated with significantly longer survival.

Cited by 40 publications

References 26 publications

Deferasirox therapy is associated with reduced mortality risk in a medicare population with myelodysplastic syndromes

Deferasirox therapy is associated with reduced mortality risk in a medicare population with myelodysplastic syndromes

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Myelodysplastic Syndromes—Many New Drugs, Little Therapeutic Progress

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