Clinical Efficacy of Chelation Therapy in Patients with Low-Risk Myelodysplastic Syndrome

SV Gritsaev, II Kostroma, AA Zhernyakova

Russian Research Institute of Hematology and Transfusiology, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024

For correspondence: Sergei Vasil’evich Gritsaev, MD, PhD, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024; Tel.: +7(812)717-54-68; e-mail: gritsaevsv@mail.ru

For citation: Gritsaev SV, Kostroma II, Zhernyakova AA. Clinical Efficacy of Chelation Therapy in Patients with Low-Risk Myelodysplastic Syndrome. Clinical oncohematology. 2019;12(2):120–4.

DOI: 10.21320/2500-2139-2019-12-2-120-124


ABSTRACT

The present literature review provides evidence that in patients with low-risk myelodysplastic syndrome and transfusion dependence blood parameters and survival rates can be improved by administration of iron chelators. Dose adequacy and therapy duration underlie clinical efficacy of chelators. Toxicity can be reduced by administrating a new formula of deferasirox that does not need to be dissolved in liquid before consuming.

Keywords: myelodysplastic syndrome, low risk, transfusion dependence, iron chelators, survival.

Received: August 20, 2018

Accepted: February 2, 2019

Read in PDF 


REFERENCES

  1. Greenberg P, Cox C, LeBeau MM, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997;89(6):2079–88.

  2. Bennett JM. Consensus statement on iron overload in myelodysplastic syndromes. Am J Hematol. 2008;83(11):858–61. doi: 10.1002/ajh.21269.

  3. Malcovati L, Porta MG, Pascutto C, et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol. 2005;23(30):7594–603. doi: 1200/JCO.2005.01.7038.

  4. Steensma DP, Bennett JM. The myelodysplastic syndromes: Diagnosis and treatment. Mayo Clin Proc. 2006;81(1):104–30. doi: 10.4065/81.1.104.

  5. Mitchell M, Gore SD, Zeidan AM. Iron chelation therapy in myelodysplastic syndromes: where do we stand? Expert Rev Hematol. 2013;6(4):397–410. doi: 10.1586/17474086.2013.814456.

  6. Gattermann N, Jarisch A, Schlag R, et al. Deferasirox treatment of iron-overloaded chelation-naive and prechelated patients with myelodysplastic syndromes in medical practice: results from the observational studies eXtend and eXjange. Eur J Haematol. 2012;88(3):260–8. doi: 10.1111/j.1600-0609.2011.01726.x.

  7. List AF, Baer MR, Steensma DP, et al. Deferasirox reduces serum ferritin and labile plasma iron in RBC transfusion-dependent patients with myelodysplastic syndrome. J Clin Oncol. 2012;30(17):2134–9. doi: 10.1200/JCO.2010.34.1222.

  8. Greenberg PL, Koller CA, Cabantchik ZI, et al. Prospective assessment of effects on iron-overload parameters of deferasirox therapy in patients with myelodysplastic syndromes. Leuk Res. 2010;34(12):1560–5. doi: 10.1016/j.leukres.2010.06.013.

  9. Remacha AF, Arrizabalaga B, Del Canizo C, et al. Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements. Ann Hematol. 2010;89(2):147–54. doi: 10.1007/s00277-009-0794-7.

  10. Rose C, Brechignac S, Vassilief D, et al. Does iron chelation therapy improve survival in regularly transfused lower risk MDS patients? A multicenter study by the GFM (Groupe Francophone des Myelodysplasies). Leuk Res. 2010;34(7):864–70. doi: 10.1016/j.leukres.2009.12.004.

  11. Malcovati L. Impact of transfusion dependency and secondary iron overload on the survival of patients with myelodysplastic syndromes. Leuk Res. 2007;31(Suppl 3):S2–6. doi: 10.1016/S0145-2126(07)70459-9.

  12. Kohgo Y, Ikuta K, Ohtake T, et al. Body iron metabolism and pathophysiology of iron overload. Int J Hematol. 2008;88(1):7–15. doi: 10.1007/s12185-008-0120-5.

  13. Andrews NC. Closing the iron gate. N Engl J Med. 2012;366(4):376–7. doi: 10.1056/NEJMcibr1112780.

  14. Gardenghi S, Marongiu MF, Ramos P, et al. Ineffective erythropoiesis in beta-thalassemia is characterized by increased iron absorption mediated by down-regulation of hepcidin and up-regulation of ferroportin. 2007;109(11):5027–35. doi: 10.1182/blood-2006-09-048868.

  15. Andrews NC. Disorders of iron metabolism. N Engl J Med. 1999;341(26):1986–95. doi: 10.1056/NEJM199912233412607.

  16. Takatoku M, Uchiyama T, Okamoto S, et al. Retrospective nationwide survey of Japanese patients with transfusion-dependent MDS and aplastic anemia highlights the negative impact of iron overload on morbidity/mortality. Eur J Haematol. 2007;78(6):487–94. doi: 10.1111/j.1600-0609.2007.00842.x.

  17. Gattermann N. Iron overload in myelodysplastic syndromes. Int J Hematol. 2018;107(1):55–63. doi: 10.1007/s12185-017-2367-1.

  18. Lyons R, Marek B, Paleyc C, et al. Relation between chelation and clinical outcomes in lower-risk patients with myelodysplastic syndromes: Registry analysis at 5 years. Leuk Res. 2017;56:88–95. doi: 10.1016/j.leukres.2017.01.033.

  19. Leitch H, Parmar A, Wells R, et al. Overall survival in lower IPSS risk MDS by receipt of iron chelation therapy, adjusting for patient-related factors and measuring from time of first red blood cell transfusion dependence: an MDS-CAN analysis. Br J Haematol. 2017;179(1):83–97. doi: 10.1111/bjh.14825.

  20. Mainous A, Tanner R, Hulihan M, et al. The impact of chelation therapy on survival in transfusional iron overload: a meta-analysis of myelodysplastic syndrome. Br J Haematol. 2014;167(5):720–3. doi: 10.1111/bjh.13053.

  21. Abraham I, Yami M, Yun S et al. Survival outcomes in iron chelated and non-chelated patients with lower-risk myelodysplastic syndromes: Review and pooled analysis of observational studies. Leuk Res. 2017;57:104–8. doi: 10.1016/j.leukres.2017.03.007.

  22. Gattermann N, Finelli C, Della Porta M, et al. Hematologic responses to deferasirox therapy in transfusion-dependent patients with myelodysplastic syndromes. Haematologica. 2012;97(9):1364–71. doi: 10.3324/haematol.2011.048546.

  23. Pullarkat V. Objectives of iron chelation therapy in myelodysplastic syndromes: more than meets the eye? Blood. 2009;114(26):5251–5. doi: 10.1182/blood-2009-07-234062.

  24. Zeidan AM, Hendrick F, Friedmann E, et al. Deferasirox therapy is associated with reduced mortality risk in a medicare population with myelodysplastic syndromes. J Comp Eff Res. 2015;4(4):327–40. doi: 10.2217/cer.15.20.

  25. Improta S, Villa MR, Volpe A, et al. Transfusion-dependent low-risk myelodysplastic patients receiving deferasirox: Long-term follow-up. Oncol Lett. 2013;6(6):1774–8. doi: 10.3892/ol.2013.1617.

  26. Breccia M, Voso M, Spiriti M, et al. An increase in hemoglobin, platelets and white blood cells levels by iron chelation as single treatment in multitransfused patients with myelodysplastic syndromes: clinical evidences and possible biological mechanisms. Ann Hematol. 2015;94(5):771–7. doi: 10.1007/s00277-015-2341-z.

  27. Delforge M, Selleslag D, Beguin Y, et al. Adequate iron chelation therapy for at least six months improves survival in transfusion-dependent patients with lower risk myelodysplastic syndromes. Leuk Res. 2014;38(5):557–63. doi: 10.1016/j.leukres.2014.02.003.

  28. Cermak J, Jonasova A, Vondrakova J, et al. A comparative study of deferasirox and deferiprone in the treatment of iron overload in patients with myelodysplastic syndromes. Leuk Res. 2013;37(12):1612–5. doi: 10.1016/j.leukres.2013.07.021.

  29. Nolte F, Angelucci E, Breccia M, et al. Updated recommendations on the management of gastrointestinal disturbances during iron chelation therapy with deferasirox in transfusion dependent patients with myelodysplastic syndrome – emphasis on optimized dosing schedules and new formulations. Leuk Res. 2015;39(10):1028–33. doi: 10.1016/j.leukres.2015.06.008.

  30. Taher AT, Origa R, Perrotta S, et al. New film-coated tablet formulation of deferasirox is well tolerated in patients with thalassemia or lower-risk MDS: Results of the randomized, phase II ECLIPSE study. Am J Hematol. 2017;92(5):420–8. doi: 10.1002/ajh.24668.

  31. Джадену® (инструкция по медицинскому применению). Швейцария: Novartis pharma, AG. Доступно по: https://www.vidal.ru/drugs/dzhadenu. Ссылка активна на 30.11.2018. [Dzhadenu® (package insert). Switzerland: Novartis pharma, AG. Available from: https://www.vidal.ru/drugs/dzhadenu. (accessed 30.11.2018) (In Russ)]