Iron Chelation Therapy for Transfusional Iron Overload

Introduction to Iron Chelators

The American College of Cardiology notes that deferoxamine, an older agent, requires parenteral administration at 20-60 mg/kg/day over 8-12 hours, 5-7 days weekly, or continuous IV for severe cases 1, 2, 3

The American Heart Association recommends deferiprone at 75-100 mg/kg/day in three divided doses for patients with cardiac T2* <20 ms or established heart failure 4
For acute cardiac decompensation, the American College of Cardiology suggests initiating continuous IV deferoxamine at 50-60 mg/kg/day for rapid cardiac iron removal 4, 3
The Annals of Oncology guidelines recommend deferasirox at 14-30 mg/kg/day for long-term maintenance therapy in patients with transfusional iron overload, with a dose range of 20-40 mg/kg/day administered as dispersible tablets 30 minutes before meals 6, 7

The American College of Cardiology states that cardiac iron removal requires several years even with intensive chelation 4, 5
The Annals of Oncology guidelines recommend starting chelation in low/intermediate-1 risk MDS patients after 20-60 RBC concentrates or ferritin >1000-2500 U/L 6, 7

The Journal of the American College of Cardiology notes that combination therapy with deferasirox plus deferoxamine shows significant improvements in liver and cardiac iron markers 1
Deferoxamine combined with deferiprone reduces myocardial iron and improves ejection fraction more effectively than deferoxamine alone 1

The American College of Cardiology recommends serum ferritin every 3 months (target <1000 ng/mL) and cardiac T2* MRI annually starting at age 10 in transfusion-dependent patients 3, 4
Weekly neutrophil monitoring with deferiprone is necessary due to agranulocytosis risk 4