Deferoxamine Versus Combined Therapy for Chelating Liver, Spleen and Bone Marrow Iron in β-Thalassemic Patients: A Quantitative Magnetic Resonance Imaging Study

Abstract

We used magnetic resonance imaging (MRI) to compare the effect of iron chelation on liver, spleen and bone marrow. We examined 21 β-thalassemic patients undergoing deferoxamine (DFO) (9/21) or combined therapy [DFO and deferiprone (L1), 12/21] with two abdominal MRI studies using T1-w/Pd-w/T2*-wGRE and T1-wTSE sequences. Changes in serum ferritin (DF%), and liver, spleen and marrow to paraspinous muscles signal intensity ratios (SI) in T1-wTSE sequence were calculated as D%=[(2^ndvalue-1^st value)/1^st value] ×100%. Negative DF% and positive D(SI)% indicated reduction of iron. Although 17/21 (80.9%) patients demonstrated reduction in ferritin, only 8/21 (38%), 7/21 (33.3%) and 7/21 (33.3%) patients had decreased liver, spleen and marrow iron. Patients undergoing combined therapy showed significantly greater reduction (Student's t-test, p < 0.05) or less increase (t-test, p <0.05) in iron stores. Combined therapy is more effective than DFO for removing and preventing liver, spleen and bone marrow iron accumulation in β-thalassemic patients. Magnetic resonance imaging is valuable for organ-specific monitoring of chelation therapy.

Keywords:

• Thalassemia
• Iron
• Chelation
• Magnetic resonance imaging (MRI)
• Liver
• Spleen
• Bone marrow