The 18th ICOC Proceedings in Athens, Greece: New Breakthrough in Thalassemia Leading to the Complete Treatment of Iron Overload and to Hundreds of Patients Achieving and Maintaining Normal Body Iron Stores. Ethical Questions on Chelation Therapy

Abstract

A new era in thalassemia and other transfusional iron loading conditions was highlighted during the 18th International Conference on Chelation (ICOC) with reports that all excess iron accumulated from transfusions could be removed using the ICOC combination protocol of deferiprone (L1) (80–100 mg/kg/day) and subcutaneous deferoxamine (DFO) (40–60 mg/kg/day, at least 3 days per week), and that normal range body iron store levels (NRBISL) could be maintained using L1 monotherapy. Hundreds of patients in Cyprus, Greece, Italy, UK and elsewhere, maintain NRBISL, some for more than 9 years, and without complications. This gold standard of complete iron overload treatment is likely to change current practices, aims and protocols because it could prevent and also reverse cardiac, liver, endocrine and other organ complications as well as the incidence of infections and hepatocellular carcinomas. The overall morbidity and mortality in thalassemia and other transfusional iron loading conditions is expected to be substantially reduced. New applications of chelating drugs include renal, neurodegenerative, infectious diseases and ischemia reperfusion injury patients. Ethical questions have been raised on the role of pharmaceutical companies, the clinicians and the Hippocratic oath in relation to chelation therapy.

Keywords:

• Thalassemia
• Iron overload
• Chelation therapy
• Deferiprone (L1)
• Deferoxamine (DFO)
• Deferasirox (DFRA)
• Normal body iron stores

ACKNOWLEDGMENTS

I would like to thank the authors and reviewers involved in the production of the 18th ICOC proceedings: Drs. A. Aessopos (First Department of Internal Medicine, University of Athens Medical School, “Laiko” Hospital, Athens, Greece), D. Loukopoulos (Biomedical Research Foundation, Academy of Athens, Athens, Greece) and S. Graphakos (BMT Unit, Aghia Sophia Children's Hospital, Athens, Greece) for assisting in the coordination of the 18th ICOC; the Hellenic Society of Haematology, Greek Thalassaemia Federation, Hellenic Protection Committee of Thalassaemia Parents and Patients (PEPPAMA), and the members of the ICOC and other scientific committees, the participants and all others who contributed to the successful organization of the 18th ICOC conference in Athens, Greece in December 2008.

Declaration of Interest: The author report no conflicts of interest. The author alone is responsible for the content and writing of this article.