Clinical consequences of iron overload in patients with myelodysplastic syndromes: the case for iron chelation therapy

ABSTRACT

Introduction: Patients with myelodysplastic syndromes (MDS) are at increased risk of iron overload due to ineffective erythropoiesis and chronic transfusion therapy. The clinical consequences of iron overload include cardiac and/or hepatic failure, endocrinopathies, and infection risk.

Areas covered: Iron chelation therapy (ICT) can help remove excess iron and ultimately reduce the clinical consequences of iron overload. The authors reviewed recent (last five years) English-language articles from PubMed on the topic of iron overload-related complications and the use of ICT (primarily deferasirox) to improve outcomes in patients with MDS.

Expert commentary: While a benefit of ICT has been more firmly established in other transfusion-dependent conditions, such as thalassemia, its role in reducing iron overload in MDS remains controversial due to the lack of prospective controlled data demonstrating a survival benefit. Orally administered chelation agents (e.g. deferasirox) are now available, and observational and/or retrospective data support a survival benefit of using ICT in MDS. The placebo-controlled TELESTO trial (NCT00940602) is currently examining the use of deferasirox in MDS patients with iron overload, and is evaluating specifically whether use of ICT to alleviate iron overload can also reduce iron overload-related complications in MDS and improve survival.

KEYWORDS:

• Myelodysplastic syndromes
• iron overload
• iron chelation therapy
• deferasirox
• deferoxamine

Declaration of interest

RS Komrokji and JM Shammo have served as speakers for Novartis Pharmaceuticals Corporation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One reviewer declares receiving honoraria and researching funding from Alexion, AbbVie, Celgene, and Novartis and declares membership on a Novartis speaker’s bureau on deferasirox. One reviewer declares speaker fees from and advisory board membership for Novartis. Reviewers have no other relevant financial relationships to disclose.

Additional information

Funding

Editorial support in the preparation of this publication was provided by Jennifer Lee, PhD, of Phase Five Communications, supported by Novartis Pharmaceuticals Corporation, which had no other involvement in the development of this publication.