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Iron Chelation

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Myelodysplastic Syndromes

Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

Abstract

Iron overload in MDS results from increased intestinal iron absorption due to ineffective erythropoiesis and, more importantly, from chronic transfusion therapy. Blood transfusions are necesssary to extend the survival of patients with MDS and improve their quality of life. However, the ensuing transfusional iron overload has a dose dependent negative impact on survival. Cardiac dysfunction appears to be relevant in this context, as a consequence of chronic anemia, age-related cardiac comorbidity, and iron overload. In addition, iron-related endothelial dysfunction and a higher risk of infection should be taken into account. Iron overload may also aggravate the bone marrow failure in MDS. Clinical trials have shown that iron chelators can improve hematopoiesis in a minority of transfusion-dependent patients. Analyses of registry data suggest that iron chelation provides a survival benefit for patients with MDS, but data from a randomized clinical trial are still lacking.

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Authors and Affiliations

  1. Department of Hematology, Oncology and Clinical Oncology, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

    Norbert Gattermann

  2. Service d’onco hématologie, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France

    Christian Rose

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  1. Medizinische Klinik und Poliklinik 1, Universitätsklinikum Dresden Medizinische Klinik und Poliklinik 1, Dresden, Sachsen, Germany

    Uwe Platzbecker

  2. Department of Hematology, Hospital Saint Louis, Paris, France

    Pierre Fenaux

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Gattermann, N., Rose, C. (2018). Iron Chelation. In: Platzbecker, U., Fenaux, P. (eds) Myelodysplastic Syndromes . Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-319-76879-3_8

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