Recommendations for initiating and monitoring iron chelation therapy in myelodysplastic syndromes.1
| 1Adapted from Bennett JM et al. Am J Hematol. 2008;83(11):858–861. Copyright 2008, Wiley-Liss Inc. Reprinted with permission of John Wiley & Sons Inc., Hoboken, USA. |
| ICT indicates iron chelation therapy; IPSS, International Prognostic Scoring System; LPI, labile plasma iron; MDS, myelodysplastic syndrome; NTBI, non-transferrin bound iron; RA, refractory anemia; RARS, refractory anemia with ring sideroblasts; ROS, reactive oxygen species; WHO, World Health Organization. |
| MDS patients who would benefit most from treatment of iron overload |
| Requiring transfusion of ≥ 2 RBC units/month for ≥ 1 year |
| Ferritin level >1000 ng/mL |
Low-risk MDS
|
| Life expectancy >1 year |
| Without comorbidities that would limit prognosis |
| Candidate for allograft |
| In whom there is a need to preserve organ function |
| Unresponsive to or ineligible for primary therapy such as immunomodulatory or hypomethylating agents |
| Monitoring Iron Overload |
| Serum ferritin |
| Transferrin saturation |
| MRI where available |
| Investigational parameters (NTBI, LPI, ROS) where available |
| Monitoring of organ function (cardiac, hepatic, endocrine) where indicated |
| At least every 3 months in patients receiving transfusions, following recommendations for individual ICT agents |
| Duration of ICT |
| As long as transfusion therapy continues |
| As long as IOL remains clinically relevant |
| 1Adapted from Bennett JM et al. Am J Hematol. 2008;83(11):858–861. Copyright 2008, Wiley-Liss Inc. Reprinted with permission of John Wiley & Sons Inc., Hoboken, USA. |
| ICT indicates iron chelation therapy; IPSS, International Prognostic Scoring System; LPI, labile plasma iron; MDS, myelodysplastic syndrome; NTBI, non-transferrin bound iron; RA, refractory anemia; RARS, refractory anemia with ring sideroblasts; ROS, reactive oxygen species; WHO, World Health Organization. |
| MDS patients who would benefit most from treatment of iron overload |
| Requiring transfusion of ≥ 2 RBC units/month for ≥ 1 year |
| Ferritin level >1000 ng/mL |
Low-risk MDS
|
| Life expectancy >1 year |
| Without comorbidities that would limit prognosis |
| Candidate for allograft |
| In whom there is a need to preserve organ function |
| Unresponsive to or ineligible for primary therapy such as immunomodulatory or hypomethylating agents |
| Monitoring Iron Overload |
| Serum ferritin |
| Transferrin saturation |
| MRI where available |
| Investigational parameters (NTBI, LPI, ROS) where available |
| Monitoring of organ function (cardiac, hepatic, endocrine) where indicated |
| At least every 3 months in patients receiving transfusions, following recommendations for individual ICT agents |
| Duration of ICT |
| As long as transfusion therapy continues |
| As long as IOL remains clinically relevant |