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Iron Chelation Therapy for Iron Overload in MDS

The iron chelation agent deferoxamine is administered via intravenous or subcutaneous routes as a long-term infusion; however, this delivery route is not ideal when considering patients’ quality of life, particularly in individuals who have just undergone transplantation, when the care burden is heaviest, says Thomas Prebet, MD, PhD. Oral iron chelation agents, such as deferasirox, are generally preferred in most settings, comments Prebet.

Patients receiving deferasirox should be monitor for gastrointestinal toxicities and renal side effects, as these may pose a problem. Many patients on deferasirox therapy will have less than 6 months of treatment, while some of these patients discontinue treatment due to disease progression, at least 20% will cease therapy because of side effect intolerance. A new enteric-coated formulation of deferasirox may be better tolerated, at least from the gastrointestinal perspective, suggests Prebet.

The dynamics of transfusion should be considered to help determine when to begin iron chelation therapy, says Prebet. If a patient is to be transfused within 2 weeks and already has 10 to 15 transfusions, he notes, administering iron chelation therapy may be preferable to waiting for iron overload to actually occur.

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