EFFICACY AND INFLUENCE OF IRON CHELATION THERAPY ON RED BLOOD CELL TRANSFUSIONS
(Abstract release date: 05/18/17)
EHA Library. Parvu A. 05/18/17; 182947; PB2234
Andrada Viorica Parvu
Contributions
Contributions
Abstract
Abstract: PB2234
Type: Publication Only
Background
Chelation therapy is recommended for transfused patients that have an elevated serum ferritin level (over 1000 microg/l), evidence of iron overload or received over 20 units of red blood cell transfusions (RBCT). Deferasirox showed efficacy and safety in maintaining or reducing body iron (assessed by liver iron concentration or serum ferritin). Iron chelation therapy was associated with hematopoiesis improvement in transfusion-dependent patients and interruption of Deferasirox treatment of transfusions dependent myelodisplastic patients produced loss of erythroid response.
Aims
Aim of the study: to assess the results of Deferasirox efficacy, side effects and to study if the number of RBCT decreased after starting Deferasirox.
Methods
We have done a retrospective, transversal study including all the adult politransfused patients treated with Deferasirox in three counties Hematology Departments of Nord-West Romanian hospitals. Criteria of Deferasirox treatment: over 20 RBCT, serum ferritine level over 1000 microg/l.
We created a data collection sheet including: demographics, information on patients’ disease, serum ferritine level at start of and during treatment, Deferasirox dose, data about dose modification, adverse effects of Deferasirox and their management, reasons for treatment discontinuating, evaluation of commorbidities that could increase serum ferritine level, number of RBCT before and after starting the treatment.
Results
We included 40 politransfused patients treated with Deferasirox, age average 63. The diagnosis included mielodysplastic syndromes (most of patients), thalassemia, other anemias. Myelodysplastic patients were treated with low dose chemotherapy, epigenetic treatment, RBCT and bethatalasemic/anemic patients were transfused. The baseline value of ferritine was between 1075 - 6187 microg/l. Deferasirox dose: 20-30 mg/kg. There was a significant reduction in serum feritine from baseline for all the patients. Ferritine median at start, 3631 microg/l decreases at 1537 microg/l after 6 months of treatment and at 994 microg/l after 12 months of treatment. There were 8 patients that had descendent levels of feritine, but during infectious episodes the ferritine increases for a short period of time.
Digestive adverse events appeared in three cases (two cases of diarrhea and one case of digestive hemorrhagic episode). In all these cases the treatment was temporarily discontinued. In three cases, treatment was stopped because low ferritin level (under 500 microg/l).
RBCT were administered before (mean 2.43 units/month) and after starting Deferasirox (mean 1.39 units/month), the difference is statistically significant (Student Test, t(39)=6.98, p<0.001). After starting Deferasirox treatment mean number of RBCT decreased, mean of differences (95% CI) was 1.04.
We analyzed the group of 23 patients treated with Deferasirox less than 12 months, and the patients treated more than 12 months, 15 patients. In both groups the difference of RBCT means (before and after the start of the treatment) are statistically significant (for the patients treated less than 12 months: Student Test, t(23)=8.12, p<0.001 and for the patient treated more than 12 months: Student test, t(15)=3.03, p=0.008).
Conclusion
Analyzing our group of 40 patients, Deferasirox proves to be effective and safe. Adverse effects that determined a temporary stop of the treatment were mild/medium short time digestive reactions. The number of red blood cell transfusion significativelly decreased after starting Deferasirox treatment.
Session topic: 30. Transfusion medicine
Keyword(s): transfusion, Chelation
Abstract: PB2234
Type: Publication Only
Background
Chelation therapy is recommended for transfused patients that have an elevated serum ferritin level (over 1000 microg/l), evidence of iron overload or received over 20 units of red blood cell transfusions (RBCT). Deferasirox showed efficacy and safety in maintaining or reducing body iron (assessed by liver iron concentration or serum ferritin). Iron chelation therapy was associated with hematopoiesis improvement in transfusion-dependent patients and interruption of Deferasirox treatment of transfusions dependent myelodisplastic patients produced loss of erythroid response.
Aims
Aim of the study: to assess the results of Deferasirox efficacy, side effects and to study if the number of RBCT decreased after starting Deferasirox.
Methods
We have done a retrospective, transversal study including all the adult politransfused patients treated with Deferasirox in three counties Hematology Departments of Nord-West Romanian hospitals. Criteria of Deferasirox treatment: over 20 RBCT, serum ferritine level over 1000 microg/l.
We created a data collection sheet including: demographics, information on patients’ disease, serum ferritine level at start of and during treatment, Deferasirox dose, data about dose modification, adverse effects of Deferasirox and their management, reasons for treatment discontinuating, evaluation of commorbidities that could increase serum ferritine level, number of RBCT before and after starting the treatment.
Results
We included 40 politransfused patients treated with Deferasirox, age average 63. The diagnosis included mielodysplastic syndromes (most of patients), thalassemia, other anemias. Myelodysplastic patients were treated with low dose chemotherapy, epigenetic treatment, RBCT and bethatalasemic/anemic patients were transfused. The baseline value of ferritine was between 1075 - 6187 microg/l. Deferasirox dose: 20-30 mg/kg. There was a significant reduction in serum feritine from baseline for all the patients. Ferritine median at start, 3631 microg/l decreases at 1537 microg/l after 6 months of treatment and at 994 microg/l after 12 months of treatment. There were 8 patients that had descendent levels of feritine, but during infectious episodes the ferritine increases for a short period of time.
Digestive adverse events appeared in three cases (two cases of diarrhea and one case of digestive hemorrhagic episode). In all these cases the treatment was temporarily discontinued. In three cases, treatment was stopped because low ferritin level (under 500 microg/l).
RBCT were administered before (mean 2.43 units/month) and after starting Deferasirox (mean 1.39 units/month), the difference is statistically significant (Student Test, t(39)=6.98, p<0.001). After starting Deferasirox treatment mean number of RBCT decreased, mean of differences (95% CI) was 1.04.
We analyzed the group of 23 patients treated with Deferasirox less than 12 months, and the patients treated more than 12 months, 15 patients. In both groups the difference of RBCT means (before and after the start of the treatment) are statistically significant (for the patients treated less than 12 months: Student Test, t(23)=8.12, p<0.001 and for the patient treated more than 12 months: Student test, t(15)=3.03, p=0.008).
Conclusion
Analyzing our group of 40 patients, Deferasirox proves to be effective and safe. Adverse effects that determined a temporary stop of the treatment were mild/medium short time digestive reactions. The number of red blood cell transfusion significativelly decreased after starting Deferasirox treatment.
Session topic: 30. Transfusion medicine
Keyword(s): transfusion, Chelation
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