Deferasirox Boosts Hematopoietic Recovery after ALLO-Sct

The attainment of transfusion independence after transplant is sometimes hampered by a combination of factors, ranging from infections to the need of combined therapy for clinical complications, as well as control of GVHD. Iron overload is frequently observed in hematological patients before and after hematopoietic stem cell transplantation (HSCT). Whereas several reports have focused on iron overload before transplant, up to now, this is the only report that show full recovery of hematopoiesis and correlate this to deferasirox chelation performed on this particular subset of patients. We report on 19 patients, transplanted for hematological diseases (17 acute leukemia, 1 aplastic anemia, 1 multiple myeloma) heavily transfused before transplant that, considering the iron overload, were treated with deferasirox after HSCT. Before starting deferasirox, the patients were fully engrafted and in complete remission, although transfusion dependent, and with incomplete hematological reconstitution after allogeneic HSCT. Patients were selected according to the following inclusion criteria: 1) transfused pre-transplant with more than 20 RBC units; 2) incomplete hematological recovery; 3) transfusion-dependence; 4) serum ferritin > 1000 ng/mL; 5) normal creatinine value. The workup for other aetiologies resulted negative. All patients received an initial dose of deferasirox 10 mg/kg/day, later adjusted according to side effects. All patients experienced an increase in hemoglobin levels, with a reduction in the frequency of RBC transfusions, followed by transfusion independence (median time: 24 days from the first dose of deferasirox). In addition, it was promptly (median time: 27 days) associated with hematological improvement, with sustained values and no further platelet support or growth factors administration. No relevant modifications with immunosuppressive or myelosuppressive drugs were made during deferasirox treatment. Deferasirox was well tolerated. Basing on our results, we think that deferasirox determined stimulatory, and/or depressive effects on hematopoiesis after allo-HSCT. In conclusion, this clinical experience raises the possibility of a potential additive benefit on hematopoiesis after transplant following iron chelation therapy with oral deferasirox. Further long term studies, in larger cohorts of patients are needed to confirm these data and design an efficient strategy to reduce iron loading after transplant. Acknowledgments: supported in part by AIL Pesaro Onlus.