Efficacy, Compliance And Toxicity Factors Are Affecting The Rate Of Normalization Of Body Iron Stores In Thalassemia Patients Using The Deferiprone And Deferoxamine Combination Therapy

Abstract

The international committee on chelation (ICOC) of deferiprone (L1) and deferoxamine (DFO) combination therapy was the first protocol reported to have achieved normal range body iron store levels (NRBISL) in β-thalassemia major (β-TM) patients. A follow-up study in eight β-TM patients has been designed to investigate the factors affecting the rate of iron removal leading to NRBISL. The patients had variable serum ferritin [mean ± SE (standard error) =1692 ± 366, range 539–3845 μg/L)] and magnetic resonance imaging (MRI) T2* relaxation times cardiac (mean ± SE =11.1 ± 2.5, range 4.5–24.2 ms) and liver (mean ± SE = 4.3 ± 1.8, range 1.4–14 ms). Organ function, blood and other biochemical parameters were regularly monitored for toxicity. The ICOC L1 (80–100 mg/kg/day) and DFO (40–60 mg/kg, at least 3 days per week) combination therapy caused an increase in cardiac (mean ± SE =30.2 ± 2.3, range 22–41 ms) and liver (mean ± SE =27.6 ± 2.8, range 9.1–35 ms) T2* and reduction in serum ferritin (mean ± SE = 158 ± 49, range 40–421 μg/L) to within the NRBISL. The rate of normalization was variable and in one case was achieved within 9 months, whereas the longest was about 3 years. The initial iron load, the rate of transfusions, the combination dose protocol and the level of compliance were the major factors affecting the rate of normalization of the iron stores. No serious toxicity was observed during the study period, which lasted a total of 24.7 patient years.

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

ACKNOWLEDGMENTS

We would like to thank Dr. Charalambos Economides at the Agios Therissos Medical Diagnostic Centre, Nicosia, Cyprus, for the MRI measurements and Alexia Ioannou and Christina Kontoghiorghe of the Postgraduate Research Institute, Technology, Environment and Medicine, Limassol, Cyprus, for helping with the preparation of the manuscript.

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