Iron overload and chelation therapy in patients with lower risk myelodysplastic syndromes

Abstract

Abstract Degree Project thesis Programme in Medicine – Iron overload and chelation therapy in patients with lower risk myelodysplastic syndromes Mathias Jerkfelt, 2015 Department of Hematology and Coagulation, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Supervisors: Sofia Grund, MD, and Hege Garelius, Department of Hematology and Coagulation, Sahlgrenska University Hospital, University of Gothenburg Background Myelodysplastic syndromes (MDS) are malignant disorders characterized by a deficient and disorderly hematopoiesis. The International Prognostic Scoring System divides the patients’ diseases into Low, Intermediate-1, Intermediate-2 and High risk. Low and Intermediate-1 are considered “lower risk” in clinical practice. Red cell transfusions are a common therapy for lower-risk MDS and therefore many patients receive a large number of transfusions during their disease which results in iron overload (IO). This may be treated with iron chelation therapy (ICT), yet the benefits in MDS patients are disputable. Aims To identify all MDS patients at Sahlgrenska University Hospital 2009-2014 that met the criteria for ICT and see how many of these patients actually were given ICT as well as look at the impact of ICT regarding transfusion dependency, S-ferritin and overall survival by comparing chelated and non-chelated patients. Methods Data was collected from the INCA-registry and electronic hospital journals. Our cohort was defined as lower risk MDS patients diagnosed or treated 2009-2014 at Sahlgrenska with end of 2014 as censoring date. We compared number of transfusions, S-ferritin-levels, overall survival and given therapy as well as other monitoring factors between chelated and non-chelated patients. Results Sixty-nine patients were found with lower-risk MDS. Twenty-seven met the criteria for ICT but only nine patients had received ICT. There were no significant differences in transfusion dependency (P=0.883) or S-ferritin (P=0.107) between the groups. Median overall survival from date of indication was 13 months longer in chelated patients (P=0.045), (23 vs 10 months, chelated and non-chelated patients). Conclusions Our results may indicate that chelation therapy could improve survival in heavily transfused lower risk MDS patients as suggested in several retrospective studies, but prospective studies are warranted.