Iron Chelation Therapy for Myelodysplastic Syndromes with Transfusional Iron Overload

Rationale for Immediate Chelation

The American Society of Hematology recommends initiating iron chelation therapy immediately in patients with serum ferritin >1000 ng/mL and significant iron burden, as evidenced by 15 units of packed red blood cell transfusions, to prevent worsening survival in MDS patients with secondary iron overload 1, 2, 3, 4
The International Working Group for Myelodysplastic Syndromes suggests that transfusion dependency with secondary iron overload is associated with a 30% increase in hazard for every 500 ng/mL increase in serum ferritin above the threshold of 1000 ng/mL 3

The National Comprehensive Cancer Network recommends monitoring serum creatinine and eGFR every 3 months, as well as liver function tests, to assess the efficacy and safety of iron chelation therapy 1, 2, 3, 4
The European Hematology Association suggests considering MRI assessment of liver iron concentration and cardiac T2* MRI every 1-2 years to monitor iron overload 5

The American Society of Hematology recommends assessing MDS risk status, as chelation is most beneficial in low-risk and intermediate-1 risk MDS patients with life expectancy exceeding 1 year 6, 7
The International Working Group for Myelodysplastic Syndromes suggests considering stem cell transplant candidacy, as chelation prior to transplant decreases procedure-related hepatic complications 1, 2, 3, 5
The National Comprehensive Cancer Network recommends preserving cardiac, hepatic, or endocrine function by initiating chelation when necessary, regardless of other factors 1, 2, 3, 4